Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Tony David Fredericks II

Individual provider Peer Specialist · NPI 1174236624

Tony David Fredericks II is a Peer Specialist in Elizabethtown, Kentucky. Practices as a sole proprietor. Registered with an NPI since 2022.

In the registry since
2022

Practice location Address checks out

100 Par Ln Ste 102
Elizabethtown, KY 42701-9059
Phone: (270) 312-2500
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Peer Specialist (primary) Taxonomy 175T00000X

Record details

NPI number1174236624
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedDecember 29, 2022
Last updated in NPPESDecember 29, 2022
Certification dateDecember 29, 2022

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