# EAST KENTUCKY MEDICAL GROUP, PSC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

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

## Provider details

- **NPI number:** 1568443422
- **Authorized official:** DR. LELA C JOHNSON M.D. (PRESIDENT)
- **Authorized official phone:** (606) 432-2172

## Contact information

- **Practice address:** 50 WEDDINGTON BRANCH RD, SUITE B, PIKEVILLE, KY 41501-3296
- **Practice address phone:** (606) 432-2172
- **Practice address fax:** (606) 433-0143
- **Mailing address:** 50 WEDDINGTON BRANCH RD, SUITE B, PIKEVILLE, KY 41501-3296
- **Mailing address phone:** (606) 432-2172
- **Mailing address fax:** (606) 433-0143

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 363LF0000X | Family Nurse Practitioner | — | NULL | — |
| 363LF0000X | Family Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 11/08/2005
- **Last updated:** 04/30/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 7100105940 | — | KY |