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General NPI Number Information
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NPI Number | 1922950062
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Entity Type | Organization
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Legal Business Name | HOMETOWN CONNECT INC
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Dates
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Enumeration Date | 02/11/2026
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Last Update Date | 02/16/2026
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Provider Practice Location Address
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Address Line | 301 BURKESVILLE ST
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City | COLUMBIA
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State | KY
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Zip | 42728-1921
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Country | US
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Telephone | 270-789-4663
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Fax |
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Provider Business Mailing Address
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Address Line | 301 BURKESVILLE ST
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City | COLUMBIA
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State | KY
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Zip | 42728-1921
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Country | US
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Telephone | 270-789-4663
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Fax |
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Authorized Official
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Title or Position | CHIEF CLINICAL OFFICER
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Name | ANTONIO LAVELLE BOOKER
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Credential | PHARMD
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Telephone | 502-599-0264
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) 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 | 363LP0200X
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Taxonomy Name | Pediatric 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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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