Organization
LAKE CUMBERLAND PHYSICIAN PRACTICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY TEAGUE (DIRECTOR)
(615) 920-7000
Entity
Organization
Contact information
Practice address
154 BOGLE OFFICE PARK DR, SUITE B, SOMERSET, KY 42503
(606) 451-3958
Mailing address
154 BOGLE OFFICE PARK DR, SUITE B, SOMERSET, KY 42503-2810
(606) 451-3958
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
—
—
2084S0012X
Sleep Medicine (Psychiatry & Neurology) Physician
—
—
363AM0700X
Medical Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
07/18/2012
Last updated
01/12/2022
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