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General NPI Number Information
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NPI Number | 1811396195
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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 | 08/22/2014
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Last Update Date | 09/23/2021
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Provider Practice Location Address
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Address Line | 26 OXFORD WAY STE B
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City | SOMERSET
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State | KY
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Zip | 42503-2813
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Country | US
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Telephone | 615-920-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 330 SEVEN SPRINGS WAY
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City | BRENTWOOD
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State | TN
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Zip | 37027
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Country | US
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Telephone | 615-920-7000
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Fax | 615-920-8775
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Authorized Official
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Title or Position | AVP
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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 | 363AS0400X
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Taxonomy Name | Surgical 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 | 363LA2100X
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Taxonomy Name | Acute Care 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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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