Provider Demographics
NPI:1710377056
Name:L & K HEALTHCARE
Entity Type:Organization
Organization Name:L & K HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP-C
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BYRD
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:270-627-3397
Mailing Address - Street 1:300 CANAL CT
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-4466
Mailing Address - Country:US
Mailing Address - Phone:270-627-3397
Mailing Address - Fax:
Practice Address - Street 1:5045 OLD HICKORY BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-2582
Practice Address - Country:US
Practice Address - Phone:270-627-3397
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-26
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN17056305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1530567Medicaid