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General NPI Number Information
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NPI Number | 1134914203
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Entity Type | Organization
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Legal Business Name | HEALTH & LIFESTYLES VIP LLC
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Dates
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Enumeration Date | 04/10/2025
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Last Update Date | 10/28/2025
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Provider Practice Location Address
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Address Line | 61 CONCORD SPUR ROAD
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City | ALBANY
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State | KY
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Zip | 42602
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Country | US
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Telephone | 606-934-0684
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Fax | 606-777-7560
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Provider Business Mailing Address
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Address Line | PO BOX 237
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City | ALBANY
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State | KY
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Zip | 42602-0237
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Country | US
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Telephone | 606-934-0684
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Fax | 606-777-7560
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Authorized Official
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Title or Position | PRESIDENT, CEO
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Name | PENNY STOCKTON LOGAN
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Credential | ARNP
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Telephone | 606-306-7706
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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