Basic Information
| Provider Information | |||||||||
| NPI: | 1326034018 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PESSA | ||||||||
| FirstName: | JOEL | ||||||||
| MiddleName: | EDWARD | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2917 | ||||||||
| Address2: | |||||||||
| City: | PIKEVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 415022917 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6062181000 | ||||||||
| FaxNumber: | 6062187506 | ||||||||
| Practice Location | |||||||||
| Address1: | 911 BYPASS RD | ||||||||
| Address2: | 6TH FLOOR CLINIC | ||||||||
| City: | PIKEVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 415011689 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6062181000 | ||||||||
| FaxNumber: | 6062187506 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2005 | ||||||||
| LastUpdateDate: | 07/23/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208200000X | 21774 | WV | N | Allopathic & Osteopathic Physicians | Plastic Surgery | 2082S0105X | 44769 | KY | Y | Allopathic & Osteopathic Physicians | Plastic Surgery | Surgery of the Hand |
No ID Information.