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General NPI Number Information
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NPI Number | 1316814908
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Entity Type | Organization
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Legal Business Name | PREMIER HEALTHCARE OF LAKE CUMBERLAND
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Dates
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Enumeration Date | 10/20/2025
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Last Update Date | 10/20/2025
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Provider Practice Location Address
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Address Line | 78 KOLSONS CT
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City | SOMERSET
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State | KY
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Zip | 42503-6458
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Country | US
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Telephone | 606-872-1138
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 235
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City | SOMERSET
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State | KY
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Zip | 42502-0235
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Country | US
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Telephone | 606-872-1138
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JOHN D SLOAN
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Credential |
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Telephone | 606-872-1138
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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