Healthcare Provider Details

I. General information

NPI: 1679195630
Provider Name (Legal Business Name): PETER JEROME YOUMANS III APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2020
Last Update Date: 08/10/2025
Certification Date: 08/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 DENNIS SANDLIN MD CV
HAZARD KY
41701-1559
US

IV. Provider business mailing address

72 BUCKHORN CLINIC RD
BUCKHORN KY
41721-8936
US

V. Phone/Fax

Practice location:
  • Phone: 606-439-2111
  • Fax:
Mailing address:
  • Phone: 606-398-7141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3014605
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: