TWIN LAKES MEDICAL FOUNDATION, INC. (NPI# 1720164825) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1720164825 |
| Entity Type | Organization |
| Organization Name | TWIN LAKES MEDICAL FOUNDATION, INC. |
| Other Organization Name | CANEYVILLE FAMILY PRACTICE NP GROUP |
| Practice Address |
301 Sunset Dr Caneyville KY 42721-9172 |
| Practice Telephone | 2708793711 |
| Practice Fax Number | 2708798674 |
| Mailing Telephone | 2708793711 |
| Mailing Fax Number | 2708798674 |
| Enumeration Date | 2006-10-31 |
| Last Update Date | 2013-04-08 |
| Authorized Official Name | LOU ELLIOTT (BUSINESS ADMINISTRATION) |
| Authorized Official Telephone | 2702599580 |
| Is Organization Subpart | Y |
| Parent Organization Name | TWIN LAKES MEDICAL FOUNDATION, INC. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363L00000X | Nurse Practitioner | Physician Assistants & Advanced Practice Nursing Providers | ||
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
KY | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| KY | 78903556 | 05 | |
| KY | PASSPORT | 1160599 | 01 |
| KY | ANTHEM | 000000302145 | 01 |
| Other Name | Type Code |
|---|---|
| CANEYVILLE FAMILY PRACTICE NP GROUP | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952616070 | Twin Lakes Medical Foundation, Inc. | Preventive Medicine | 1895 Elizabethtown Rd., Leitchfield, KY 42754-9138 | 2010-08-12 |
| 1053638288 | Twin Lakes Medical Foundation, Inc. | Internal Medicine | 910 Wallace Ave, Leitchfield, KY 42754-2414 | 2010-04-28 |
| 1295052975 | Twin Lakes Medical Foundation, Inc. | Nurse Practitioner | 912 Wallace Ave, Leitchfield, KY 42754-2404 | 2010-04-21 |
| 1871821454 | Twin Lakes Medical Foundation, Inc. | Internal Medicine | 912 Wallace Ave, Leitchfield, KY 42754-2404 | 2009-11-19 |
| 1275762221 | Twin Lakes Medical Foundation, Inc. | Nurse Practitioner | 9847 Elizabethtown Rd, Big Clifty, KY 42712-5880 | 2009-07-13 |
| 1730337726 | Twin Lakes Medical Foundation, Inc. | Pediatrics | 9847 Elizabethtown Rd, Big Clifty, KY 42712-5880 | 2008-09-03 |
| 1326214172 | Twin Lakes Medical Foundation, Inc. | Hearing Instrument Specialist | 910 Wallace Ave, Leitchfield, KY 42754-2414 | 2008-05-01 |
| 1861668618 | Twin Lakes Medical Foundation, Inc. | Obstetrics & Gynecology | 910 Wallace Ave, Leitchfield, KY 42754-2414 | 2008-05-01 |
| 1902982002 | Twin Lakes Medical Foundation, Inc. | Nurse Practitioner | 910 Wallace Ave, Leitchfield, KY 42754-2414 | 2006-10-31 |
| 1003820812 | Twin Lakes Medical Foundation, Inc. | Pediatrics | 912 Wallace Ave, Leitchfield, KY 42754-2404 | 2006-07-28 |
| Street Address |
301 SUNSET DR |
| City | CANEYVILLE |
| State | KY |
| Zip Code | 42721-9172 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447253786 | Robert E Mcclure | Family Medicine | 301 Sunset Dr, Caneyville, KY 42721 | 2005-05-31 |
| 1164054664 | Grayson County Hospital Foundation Inc | Clinic/Center | 301 Sunset Dr, Caneyville, KY 42721-9172 | 2020-02-12 |
| 1205895943 | Gregory Thomas Koo | Specialist | 301 Sunset Dr, Caneyville, KY 42721-9172 | 2006-03-21 |
| 1104822360 | Todd E Bullock | Nurse Practitioner | 301 Sunset Dr, Caneyville, KY 42721-9172 | 2005-06-22 |
| 1013910504 | Twin Lakes Medical Foundation, Inc. | General Practice | 301 Sunset Dr, Caneyville, KY 42721-9172 | 2005-05-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477627057 | Mike J Utley | Dentist | 528 East Maple Street, Caneyville, KY 42721 | 2006-11-17 |
| 1467439083 | Midway Pharmacy of Clarkson, Inc | Durable Medical Equipment & Medical Supplies | 408 East Maple Street, Caneyville, KY 42721 | 2005-12-23 |
| 1770906513 | Shelly Geary | Nurse Practitioner | 4162 Falls of Rough Rd, Caneyville, KY 42721-9037 | 2014-01-30 |
| 1144769274 | Martha Gary | Behavior Technician | 527 E Maple St, Caneyville, KY 42721-9060 | 2017-02-22 |
| 1144207432 | Embry Welding Supply Inc | Durable Medical Equipment & Medical Supplies | 10 Industrial Dr, Caneyville, KY 42721-9176 | 2005-12-28 |
| 1174708705 | Embry Medical Supply | Durable Medical Equipment & Medical Supplies | 10 Industrial Dr, Caneyville, KY 42721-9176 | 2008-01-02 |
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770906513 | Shelly Geary | Nurse Practitioner | 4162 Falls of Rough Rd, Caneyville, KY 42721-9037 | 2014-01-30 |
| 1104822360 | Todd E Bullock | Nurse Practitioner | 301 Sunset Dr, Caneyville, KY 42721-9172 | 2005-06-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013518661 | Kimberly Sue Moore | Nurse Practitioner | 1196 Sardis Rd, Mount Olivet, KY 41064-7580 | 2020-11-02 |
| 1740880640 | Kristie Lynn Hale | Nurse Practitioner | 521 East Cumberland Gap Parkway, Suite 1, Corbin, KY 40701 | 2020-10-29 |
| 1053911065 | Ashley Renee Smith | Nurse Practitioner | 8367 Stonelick Rd, Maysville, KY 41056-9432 | 2020-10-28 |
| 1629677117 | Shelby A Rollings | Nurse Practitioner | 100 Clint Hill Blvd, Paducah, KY 42001-6771 | 2020-10-26 |
| 1023618535 | Pamela Nicole Kinney | Nurse Practitioner | 13503 Terrace Creek Dr Apt 203, Louisville, KY 40245-5838 | 2020-10-26 |
| 1710586466 | Jamie Rae Ratcliff | Nurse Practitioner | 141 Ky Route 1428, Prestonsburg, KY 41653-1506 | 2020-10-23 |
| 1518566371 | Kelly Rae Smith | Nurse Practitioner | 13402 Creekview Rd, Prospect, KY 40059-9028 | 2020-10-22 |
| 1952900870 | Sarah Elizabeth Clark | Nurse Practitioner | 1309 Morning Side Ct, Lexington, KY 40509-2353 | 2020-10-21 |
| 1942809033 | Lauren Elizabeth Tobler | Nurse Practitioner | 32 Burdsall Ave, Fort Mitchell, KY 41017-2802 | 2020-10-20 |
| 1629677745 | Lisa Elaine Coleman | Nurse Practitioner | 2241 Gulfstream Dr, Lexington, KY 40504-3273 | 2020-10-20 |
| Find all providers with the same taxonomy | ||||
| City | CANEYVILLE |
| Zip Code | 42721 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.