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General NPI Number Information
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NPI Number | 1386999027
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Entity Type | Organization
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Legal Business Name | LAKE CUMBERLAND PHYSICIAN PRACTICES LLC
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Dates
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Enumeration Date | 07/18/2012
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Last Update Date | 01/12/2022
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Provider Practice Location Address
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Address Line | 154 BOGLE OFFICE PARK DR SUITE B
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City | SOMERSET
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State | KY
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Zip | 42503
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Country | US
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Telephone | 606-451-3958
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Fax |
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Provider Business Mailing Address
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Address Line | 154 BOGLE OFFICE PARK DR SUITE B
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City | SOMERSET
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State | KY
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Zip | 42503-2810
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Country | US
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Telephone | 606-451-3958
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | KATHY TEAGUE
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Credential |
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Telephone | 615-920-7000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084S0012X
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Taxonomy Name | Sleep Medicine (Psychiatry & Neurology) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State |
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