Organization
SPECIALTY PHYSICIAN ASSISTANT,LLC
Active
Other names
Russell Fork Walk-In Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
NICHOL BURCHFIELD PA-C (OWNER/MEMBER)
(606) 422-4764
Entity
Organization
Contact information
Practice address
17401 KY HIGHWAY 80 E, ELKHORN CITY, KY 41522-8226
(606) 754-7100
(606) 754-0770
Mailing address
PO BOX 2122, PIKEVILLE, KY 41502-2122
(606) 754-7100
(606) 754-0770
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
KY
261Q00000X
Clinic/Center
Primary
—
KY
363A00000X
Physician Assistant
—
KY
363L00000X
Nurse Practitioner
—
KY
Other
Enumeration date
03/07/2014
Last updated
11/29/2023
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