Organization
LEITCHFIELD PEDIATRIC CLINIC P.S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LYNN ROBINSON (CREDITIALING)
(270) 259-5641
Entity
Organization
Contact information
Practice address
901 WALLACE AVE, LEITCHFIELD, KY 42754-1417
(270) 259-5641
(270) 259-5309
Mailing address
901 WALLACE AVE, LEITCHFIELD, KY 42754-1417
(270) 259-5641
(270) 259-5309
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
—
—
261QR1300X
Rural Health Clinic/Center
Primary
—
—
363LP0200X
Pediatric Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
65926883
—
KY
Enumeration date
05/27/2006
Last updated
10/20/2020
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