Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Kenneth Richard Phelps, PA-C

Individual provider Physician Assistant · NPI 1669807210

Kenneth Richard Phelps, PA-C is a Physician Assistant in Jacksonville, Florida. Graduated from At Still University, Arizona School of Dentistry & Oral Hlth in 2013, 13 years ago. Practices with Summit Radiology Services P C, a 70-clinician group and accepts Medicare assignment. Licensed in Florida.

Years since qualifying
13
Trained at
At Still University, Arizona School of Dentistry & Oral Hlth
Licensed in
FL
In the registry since
2013
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

3599 University Blvd S Bldg 300
Jacksonville, FL 32216-4252
Phone: (904) 399-5550
Fax: (904) 346-4334
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence PA9107403 (FL)

Record details

NPI number1669807210
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorNo
NPI enumeratedSeptember 13, 2013
Last updated in NPPESFebruary 26, 2021
Certification dateFebruary 26, 2021

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolAT STILL UNIVERSITY, ARIZONA SCHOOL OF DENTISTRY & ORAL HLTH
Graduated 2013 (13 years in practice)
Group practice Summit Radiology Services P C — 70 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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