DR. KELLEY 'CORKY' DEATON III (NPI# 1851441802) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1851441802 |
| Entity Type | Individual |
| Full Name | DR. KELLEY 'CORKY' DEATON III |
| Credential | DMD |
| Practice Address |
359 S 4th St Suite C Danville KY 40422-2078 |
| Practice Telephone | 8592365703 |
| Practice Fax Number | 8599361916 |
| Mailing Telephone | 8592365703 |
| Mailing Fax Number | 8599361916 |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2015-03-11 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 122300000X | Dentist | 5843 | KY | Dental Providers |
| Y | 1223G0001X |
Dentist Specialization: General Practice |
5843 | KY | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| KY | EPSDT DENTAL ID | 45601382 | 01 |
| KY | TAX ID | 61-1180059 | 01 |
| KY | 60058435 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326387044 | Kelley Deaton | Nurse Practitioner | 171 Ashley Ave, Charleston, SC 29425-8908 | 2013-02-01 |
| Street Address |
359 S 4TH ST SUITE C |
| City | DANVILLE |
| State | KY |
| Zip Code | 40422-2078 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346233129 | Mark C Ward | Optometrist | 359 S 4th St, Danville, KY 40422-2078 | 2005-08-26 |
| 1063916898 | Tonya Lynn Owens | Counselor | 359 S 4th St, Danville, KY 40422-2078 | 2018-03-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568098754 | Healthstat Onsite Clinic Centre College | Preventive Medicine | 851 West Walnut St, Danville, KY 40422 | 2020-03-19 |
| 1134772288 | Austin Simpson | Physician Assistant | 217 South 3rd Street, Danville, KY 40422 | 2019-07-18 |
| 1033677695 | Shannon Holland Erwin | Counselor | 475 W Main St Suite 160, Danville, KY 40422 | 2019-03-03 |
| 1225556871 | Fallon Michelle Carnes | Counselor | 106 Belinda Blvd., Danville, KY 40422 | 2017-09-05 |
| 1780124529 | Natasha Taylor | Counselor | 461 South 4th Street, Danville, KY 40422 | 2017-02-27 |
| 1184088890 | Elizabeth Love | Counselor | 108 Saint Josephs Ct, Danville, KY 40422 | 2016-04-08 |
| 1801274550 | Jeremy Tate Johnson | Specialist/Technologist | 1637 Perryville Rd., Boyle County High School, Danville, KY 40422 | 2015-05-14 |
| 1649602228 | Susan Hale Couzens | Dentist | 435 Whirlaway Dr, Danville, KY 40422 | 2013-08-06 |
| 1265751200 | William Paul Baas | Ophthalmology | 440 W. Martin L. King Blvd., Suite 100, Danville, KY 40422 | 2010-05-28 |
| 1780823666 | Karen Totsuka IIi | Speech-Language Pathologist | 642 Nth 3rd St, Danville, KY 40422 | 2009-02-17 |
| Find all providers in zip 40422 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053912121 | Danville Downtown Dentistry LLC | Dentist | 94 S Tennessee St, Danville, IN 46122-1836 | 2020-11-05 |
| 1487213583 | Austin Lee Moon | Dentist | 770 Piney Forest Rd Ste A, Danville, VA 24540-2876 | 2019-06-12 |
| 1306343868 | Danville Dental Associates, PC | Dentist | 5011 Riverside Dr Ste B, Danville, VA 24541-5642 | 2018-04-11 |
| 1982126322 | Jennifer Hudson Begley | Dentist | 116 Skywatch Dr Ste A, Danville, KY 40422-2537 | 2017-07-07 |
| 1407392384 | Swati Mukul Kumar | Dentist | 116 Skywatch Dr # A, Danville, KY 40422-2537 | 2017-01-16 |
| 1922450659 | Samba Norris | Dentist | 706 S Market Street, Danville, OH 43014 | 2016-07-06 |
| 1639575913 | Riverview Dental Care, P.C. | Dentist | 4035 Riverside Dr, Danville, VA 24541-5152 | 2014-11-13 |
| 1780097535 | Matthew Murdock | Dentist | 4 Wesner Ln, Danville, PA 17821-8023 | 2014-06-10 |
| 1871866558 | Stephen Randall Snow | Dentist | 909 San Ramon Valley Blvd Ste 216, Danville, CA 94526-4038 | 2012-02-11 |
| 1386945368 | Valerie Johnston | Dentist | 156 Diablo Rd, Suite 202, Danville, CA 94526-3312 | 2010-11-08 |
| Find all providers in DANVILLE | ||||
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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.