Healthcare Provider Details

I. General information

NPI: 1528484037
Provider Name (Legal Business Name): SPECIALTY PHYSICIAN ASSISTANT,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2014
Last Update Date: 11/29/2023
Certification Date: 11/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17401 KY HIGHWAY 80 E
ELKHORN CITY KY
41522-8226
US

IV. Provider business mailing address

PO BOX 2122
PIKEVILLE KY
41502-2122
US

V. Phone/Fax

Practice location:
  • Phone: 606-754-7100
  • Fax: 606-754-0770
Mailing address:
  • Phone: 606-754-7100
  • Fax: 606-754-0770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateKY
# 4
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateKY

VIII. Authorized Official

Name: NICHOL BURCHFIELD
Title or Position: OWNER/MEMBER
Credential: PA-C
Phone: 606-422-4764