Provider Demographics
NPI:1386190171
Name:PELT, ELISABETH A
Entity Type:Individual
Prefix:
First Name:ELISABETH
Middle Name:A
Last Name:PELT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 NORTH EAGLE CREEK
Mailing Address - Street 2:STE 200
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-1800
Mailing Address - Country:US
Mailing Address - Phone:859-338-8268
Mailing Address - Fax:859-263-8073
Practice Address - Street 1:140 NORTH EAGLE CREEK
Practice Address - Street 2:STE 200
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1800
Practice Address - Country:US
Practice Address - Phone:859-338-8268
Practice Address - Fax:859-263-8073
Is Sole Proprietor?:No
Enumeration Date:2016-08-31
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3009857363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology