Healthcare Provider Details

I. General information

NPI: 1265372874
Provider Name (Legal Business Name): NOMAD IV LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2026
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

699 GINGERMILL LN
LEXINGTON KY
40509-1917
US

IV. Provider business mailing address

699 GINGERMILL LN
LEXINGTON KY
40509-1917
US

V. Phone/Fax

Practice location:
  • Phone: 606-367-3681
  • Fax:
Mailing address:
  • Phone: 606-367-3681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TREVOR JAMES STOVALL
Title or Position: OWNER
Credential: RN
Phone: 606-367-3681