WILLIAM ROBERT REVELETTE (NPI# 1639146996) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639146996 |
| Entity Type | Individual |
| Full Name | WILLIAM ROBERT REVELETTE |
| Credential | MD |
| Practice Address |
1250 Keene Rd Suite 104 Nicholasville KY 40356-7600 |
| Mailing Address |
Po Box 936 London KY 40743-0936 |
| Practice Telephone | 8598876851 |
| Practice Fax Number | 8598876878 |
| Mailing Fax Number | 6063307825 |
| Enumeration Date | 2006-03-07 |
| Last Update Date | 2019-07-11 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 208000000X | Pediatrics | 31337 | KY | Allopathic & Osteopathic Physicians |
| Y | 2080A0000X |
Pediatrics Specialization: Adolescent Medicine |
31337 | KY | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| KY | 64313372 | 05 |
| Street Address |
1250 KEENE RD SUITE 104 |
| City | NICHOLASVILLE |
| State | KY |
| Zip Code | 40356-7600 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619974805 | Stephen S Draper | Family Medicine | 1250 Keene Rd, Suite 102, Nicholasville, KY 40356-7600 | 2005-07-01 |
| 1952703340 | Kathryn Moody | Pharmacist | 1250 Keene Rd, Nicholasville, KY 40356-7600 | 2014-09-17 |
| 1932457041 | Saint Joseph Medical Foundation, Inc. | Pediatrics | 1250 Keene Rd, Ste 104, Nicholasville, KY 40356-7600 | 2012-08-21 |
| 1427290931 | Commonwealth Urology Nicholasville | Urology | 1250 Keene Rd, Nicholasville, KY 40356-7600 | 2009-03-30 |
| 1467699249 | Saint Joseph Medical Foundation, Inc | Family Medicine | 1250 Keene Rd, Ste 102, Nicholasville, KY 40356 | 2009-01-15 |
| 1073723854 | Kathy Lynn Bolton | Nurse Practitioner | 1250 Keene Rd, Nicholasville, KY 40356-7600 | 2007-05-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609414507 | Samantha Johanne Tatum | Occupational Therapist | 610 E Brannon Road Suite 200, Nicholasville, KY 40356 | 2019-12-11 |
| 1083117279 | Michelle M Harrison | Counselor | 100 W. Maple Street, Nicholasville, KY 40356 | 2018-03-14 |
| 1427598226 | Margaret Osbourne | Counselor | 101a Wind Haven Drive, Suite 203, Nicholasville, KY 40356 | 2017-02-28 |
| 1265818421 | Amanda Marie Sciretta | Speech-Language Pathologist | 105 Windhaven Drive, Suite 1, Nicholasville, KY 40356 | 2015-08-10 |
| 1538568720 | Carmen T Wurtz | Physical Therapist | 602 Keene Centre Dr, Nicholasville, KY 40356 | 2014-08-14 |
| 1780093609 | Kristin Borrelli | Psychologist | 2513 Bethel Rd, Nicholasville, KY 40356 | 2014-08-05 |
| 1003169343 | Megan Brittany Young | Occupational Therapist | 1123 Holloway Lane, Nicholasville, KY 40356 | 2012-10-24 |
| 1801145412 | Brannon Crossing Family Dental, Pllc | Dentist | 231 East Brannon Rd, Nicholasville, KY 40356 | 2012-08-29 |
| 1821392135 | The Methodist Home of Ky | Case Management | 1115 Ashgrove Road, Nicholasville, KY 40356 | 2010-12-29 |
| 1083934053 | Benjamin J Heckman | Dentist | 117 Bryant Dr, Nicholasville, KY 40356 | 2010-06-01 |
| Find all providers in zip 40356 | ||||
| Taxonomy Code | 2080A0000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Adolescent Medicine |
| A pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649613852 | Michael W Simon, M.d. | Pediatrics | 610 E Brannon Rd, Nicholasville, KY 40356-6066 | 2013-04-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154715159 | Gregory Tracy | Pediatrics | 3050 Harrodsburg Rd Ste 100, Lexington, KY 40503 | 2015-03-27 |
| 1497088090 | Henderson Pediatrics, Psc | Pediatrics | 1035 N Elm St, Henderson, KY 42420-2712 | 2009-09-14 |
| 1679773154 | Sheila M Guelda Md Pllc | Pediatrics | 2809 N Hurstbourne Pkwy, Suite 109, Louisville, KY 40223-1279 | 2007-07-23 |
| 1235296617 | Suzanne L Woods | Pediatrics | 301 C Middletown Park Place, Louisville, KY 40243 | 2007-01-03 |
| 1811062151 | Winit Chartisathian | Pediatrics | 73 Kingswood Dr, Campbellsville, KY 42718-9604 | 2006-11-22 |
| 1871694174 | Angelito L Samson | Pediatrics | 150 Frankfort Rd, Suite 101, Shelbyville, KY 40065-9433 | 2006-09-26 |
| 1558376392 | Robert J Tagher | Pediatrics | 7409 Us Highway 42, Florence, KY 41042-1905 | 2006-07-30 |
| 1710947817 | Paul J Janson | Pediatrics | 7370 Turfway Road, Suite 280, Florence, KY 41042 | 2006-03-24 |
| 1457331555 | Debra R. Bailey | Pediatrics | 419 Town Mountain Road, Suite 202, Pikeville, KY 41501-1633 | 2006-01-17 |
| 1700863230 | Dana J Distler | Pediatrics | 301 Middletown Park Pl, Suite C, Louisville, KY 40243-2515 | 2005-12-27 |
| Find all providers with the same taxonomy | ||||
| City | NICHOLASVILLE |
| Zip Code | 40356 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.