Provider Demographics
NPI:1528484037
Name:SPECIALTY PHYSICIAN ASSISTANT,LLC
Entity type:Organization
Organization Name:SPECIALTY PHYSICIAN ASSISTANT,LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:NICHOL
Authorized Official - Middle Name:
Authorized Official - Last Name:BURCHFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:606-422-4764
Mailing Address - Street 1:PO BOX 2122
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41502-2122
Mailing Address - Country:US
Mailing Address - Phone:606-754-7100
Mailing Address - Fax:606-754-0770
Practice Address - Street 1:17401 KY HIGHWAY 80 E
Practice Address - Street 2:
Practice Address - City:ELKHORN CITY
Practice Address - State:KY
Practice Address - Zip Code:41522-8226
Practice Address - Country:US
Practice Address - Phone:606-754-7100
Practice Address - Fax:606-754-0770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-07
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY207Q00000X, 363A00000X, 363L00000X, 261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty