# TWIN LAKES MEDICAL FOUNDATION INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1205870862
- **Authorized official:** DENEACE CLEMONS (COO)
- **Authorized official phone:** (270) 259-1626

## Contact information

- **Practice address:** 908 WALLACE AVE, LEITCHFIELD, KY 42754-1479
- **Practice address phone:** (270) 259-1626
- **Practice address fax:** (270) 259-9582
- **Mailing address:** 908 WALLACE AVE, LEITCHFIELD, KY 42754-1479
- **Mailing address phone:** (270) 259-1626
- **Mailing address fax:** (270) 259-9582

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | — |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 207QS0010X | Sports Medicine (Family Medicine) Physician | — | NULL | — |
| 207QS0010X | Sports Medicine (Family Medicine) Physician | — | — | — |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |
| 207V00000X | Obstetrics & Gynecology Physician | — | NULL | — |
| 207V00000X | Obstetrics & Gynecology Physician | — | — | — |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | — |
| 207X00000X | Orthopaedic Surgery Physician | — | — | — |
| 207Y00000X | Otolaryngology Physician | — | NULL | — |
| 207Y00000X | Otolaryngology Physician | — | — | — |
| 208000000X | Pediatrics Physician | — | NULL | — |
| 208000000X | Pediatrics Physician | — | — | — |
| 2084N0400X | Neurology Physician | — | NULL | — |
| 2084N0400X | Neurology Physician | — | — | — |
| 208600000X | Surgery Physician | — | NULL | — |
| 208600000X | Surgery Physician | — | — | — |
| 208D00000X | General Practice Physician | — | NULL | — |
| 208D00000X | General Practice Physician | — | — | — |
| 231H00000X | Audiologist | — | NULL | — |
| 231H00000X | Audiologist | — | — | — |
| 363L00000X | Nurse Practitioner | — | NULL | Yes |
| 363L00000X | Nurse Practitioner | — | — | Yes |
| 363LA2200X | Adult Health Nurse Practitioner | — | NULL | — |
| 363LA2200X | Adult Health Nurse Practitioner | — | — | — |
| 363LF0000X | Family Nurse Practitioner | — | NULL | — |
| 363LF0000X | Family Nurse Practitioner | — | — | — |
| 363LP2300X | Primary Care Nurse Practitioner | — | NULL | — |
| 363LP2300X | Primary Care Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 06/15/2006
- **Last updated:** 12/09/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 65923997 | — | KY |
| 05 | — | 65937047 | — | KY |
| 05 | — | 65937930 | — | KY |
| 05 | — | 65939019 | — | KY |
| 05 | — | 65943045 | — | KY |
| 05 | — | 70900162 | — | KY |
| 05 | — | 7100011670 | — | KY |
| 05 | — | 7100072530 | — | KY |
| 05 | — | 7100086880 | — | KY |
| 05 | — | 7100118990 | — | KY |
| 05 | — | 7100124530 | — | KY |
| 05 | — | 7100161750 | — | KY |
| 05 | — | 7100566530 | — | KY |
| 05 | — | 7100630070 | — | KY |
| 05 | — | 78903556 | — | KY |