Individual
DR. KEVIN PETTUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7786 LEXINGTON RD, LANCASTER, KY 40444-9119
(859) 548-4114
(859) 548-2718
Mailing address
PO BOX 2185, DANVILLE, KY 40423-2185
(859) 548-4114
(859) 548-2718
Taxonomy
Speciality
Code
Description
License number
State
173000000X
Legal Medicine
41148
KY
207Q00000X
Family Medicine Physician
01056257A
IN
207Q00000X
Family Medicine Physician
Primary
41148
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000536447
BCBS-BGC STANFORD PLLC
KY
01
—
000000536456
BCBS-STANFORD FAMILY MED
KY
01
—
000000536458
BCBS-BGC LIBERTY, PLLC
KY
Enumeration date
11/30/2006
Last updated
07/31/2009
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