Provider Demographics
NPI:1417589706
Name:PREWITT, ADAM (APRN)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:PREWITT
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 EXECUTIVE PARK
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207
Mailing Address - Country:US
Mailing Address - Phone:502-907-0356
Mailing Address - Fax:502-919-9780
Practice Address - Street 1:100 LONDON MOUNTAIN VIEW DR FL 1
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-6668
Practice Address - Country:US
Practice Address - Phone:859-275-5229
Practice Address - Fax:859-977-2683
Is Sole Proprietor?:No
Enumeration Date:2020-02-05
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3014139363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300035090Medicaid
KYP02504366OtherRAILROAD MEDICARE
279842OtherSIHO PROVIDER ID NUMBER
CS2009900478OtherCARESOURCE PROVIDER ID NUMBER
KY7100648480Medicaid
000001344929OtherANTHEM PROVIDER ID NUMBER
7326100OtherUNITED HEALTHCARE PROVIDER ID NUMBER
KY2165245OtherWELLCARE OF KENTUCKY PROVIDER ID NUMBER
KYPDZ000000438558OtherAETNA BETTER HEALTH OF KENTUCKY PROVIDER ID NUMBER