Organization Name: | TWIN LAKES MEDICAL FOUNDATION, INC. |
NPI Number: | 1205870862 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DENEACE CLEMONS (COO) |
Mailing Address: | 908 Wallace Ave Leitchfield |
State: | KY US |
Postal Code: | 427541479 |
Phone Number: | 2702591626 |
Fax Number: | 2702599582 |
NPI Enumeration Date: | 06/15/2006 |
NPI Last Update Date: | 07/17/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LA2200X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Adult Health |
Taxonomy Definition: |