Healthcare Provider Details

I. General information

NPI: 1801529854
Provider Name (Legal Business Name): PREMIER PEDIATRICS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2022
Last Update Date: 09/03/2022
Certification Date: 09/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2408 SIR BARTON WAY STE 125
LEXINGTON KY
40509-8303
US

IV. Provider business mailing address

1857 GOODPASTER WAY
LEXINGTON KY
40505-9005
US

V. Phone/Fax

Practice location:
  • Phone: 859-810-7337
  • Fax:
Mailing address:
  • Phone: 859-229-5198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. LAUREN KOSTELNIK
Title or Position: PHYSICIAN OWNER
Credential: DO
Phone: 859-229-5198