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General NPI Number Information
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NPI Number | 1801529854
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Entity Type | Organization
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Legal Business Name | PREMIER PEDIATRICS, PLLC
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Dates
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Enumeration Date | 07/07/2022
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Last Update Date | 09/03/2022
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Provider Practice Location Address
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Address Line | 2408 SIR BARTON WAY STE 125
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City | LEXINGTON
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State | KY
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Zip | 40509-8303
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Country | US
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Telephone | 859-810-7337
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Fax |
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Provider Business Mailing Address
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Address Line | 1857 GOODPASTER WAY
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City | LEXINGTON
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State | KY
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Zip | 40505-9005
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Country | US
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Telephone | 859-229-5198
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN OWNER
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Name | DR. LAUREN KOSTELNIK
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Credential | DO
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Telephone | 859-229-5198
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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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 | 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 #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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