Organization
PINELAKE PHYSICIAN PRACTICE LLC
Active
Other names
Jackson Purchase Primary Care - Clinton Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
SHARLEE LEBLEU (SR DIRECTOR, PROVIDER ENROLLMENT)
(615) 920-7192
Entity
Organization
Contact information
Practice address
106 W CLAY ST, CLINTON, KY 42031-1317
(270) 653-0220
(270) 653-0221
Mailing address
330 SEVEN SPRINGS WAY, BRENTWOOD, TN 37027-5098
(615) 920-7192
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207VX0000X
Obstetrics Physician
—
—
261QR1300X
Rural Health Clinic/Center
Primary
—
—
363L00000X
Nurse Practitioner
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Enumeration date
02/01/2019
Last updated
06/11/2019
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