Provider Demographics
NPI:1801529854
Name:PREMIER PEDIATRICS, PLLC
Entity type:Organization
Organization Name:PREMIER PEDIATRICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:KOSTELNIK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:859-229-5198
Mailing Address - Street 1:1857 GOODPASTER WAY
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40505-9005
Mailing Address - Country:US
Mailing Address - Phone:859-229-5198
Mailing Address - Fax:
Practice Address - Street 1:2408 SIR BARTON WAY STE 125
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-8303
Practice Address - Country:US
Practice Address - Phone:859-810-7337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-07
Last Update Date:2022-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty