Healthcare Provider Details

I. General information

NPI: 1841630654
Provider Name (Legal Business Name): EASTERN PULASKI RURAL HEALTH CLINIC,PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2013
Last Update Date: 03/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 MARK SHOPVILLE RD
SOMERSET KY
42503
US

IV. Provider business mailing address

31 MARK SHOPVILLE RD
SOMERSET KY
42503
US

V. Phone/Fax

Practice location:
  • Phone: 606-636-4214
  • Fax: 606-636-4215
Mailing address:
  • Phone: 606-636-4214
  • Fax: 606-636-4215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number900286
License Number StateKY

VIII. Authorized Official

Name: DIANA LYNN WILLIAMSON
Title or Position: APRN
Credential: APRN
Phone: 606-485-4553