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Organization

COMMONWEALTH COMMUNITY CARE CENTERS, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. YVETTE WISENER CPC (BILLING)
(256) 258-9603
Entity
Organization

Contact information

Practice address
154 N LAKE DR, PRESTONSBURG, KY 41653-1270
(606) 506-5093
(606) 506-5039
Mailing address
156 NORTH LAKE DRIVE, PRESTONBURG, KY 41653
(606) 506-5093
(606) 506-5039

Taxonomy

Speciality
Code
Description
License number
State
207NS0135X
Procedural Dermatology Physician
Primary
207V00000X
Obstetrics & Gynecology Physician
363LF0000X
Family Nurse Practitioner

Other

Enumeration date
02/06/2020
Last updated
09/02/2022
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