PATRIOT ONE PRIMARY CARE PSC NPI 1699410548

NPI Information

  • NPI: 1699410548
  • Provider Name: PATRIOT ONE PRIMARY CARE PSC
  • Classification: Physician Assistant - 363AM0700X
  • Specialization: Medical
  • Entity Type: Organization
  • CLIA Number: 18D2270238
  • Address: 989 GOVERNORS LN STE 220
    LEXINGTON, KY
    ZIP 40513
  • Phone: (859) 447-8014

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NPI Details

PATRIOT ONE PRIMARY CARE PSC is a medical physician assistant in Lexington, KY. PATRIOT ONE PRIMARY CARE PSC NPI is 1699410548. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

989 GOVERNORS LN STE 220
LEXINGTON, KY
ZIP 40513-175
Phone: (859) 447-8014
Fax: (859) 447-8013

The provider's authorized official is Elizabeth Mentzer .
The authorized official title is Owner and has the following contact phone number (859) 447-8014.

The CLIA number assigned to this NPI record is 18D2270238 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 5/4/2022 and was last updated on 8/2/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363LP0200XNurse PractitionerPediatricsNo
2363AM0700XPhysician AssistantMedicalYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
17100137000MEDICAIDKENTUCKY

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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