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PINELAKE PHYSICIAN PRACTICE LLC
NPI 1205494085
Clinic/Center - Rural Health in Hickman, KY

Active since June 05, 2019
2003 S 7TH ST, HICKMAN, KY 42050(270) 236-3337(270) 236-3340 Get Directions Write a Review

NPPES record last updated: July 16, 2026. Verified against the NPPES registry weekly; last sync: September 27, 2026.

Record update history: Jul 16, 2026, Aug 24, 2022, Jul 19, 2021 and 1 more (4 updates tracked since 2019).

About Pinelake Physician Practice Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PINELAKE PHYSICIAN PRACTICE LLC (NPI 1205494085), doing business as Jackson Purchase Primary Care Hickman Clinic, is a healthcare organization registered as a rural health in Hickman, Kentucky and active in the NPI registry since June 2019. The organization lists Charlotte Lawrence, Secretary, as its authorized official.

NPPES Registry Identity

NPI1205494085
Entity TypeOrganization
Primary Taxonomy261QR1300X
Legal Business NamePINELAKE PHYSICIAN PRACTICE LLC
Location Address2003 S 7TH STHickman, KY 42050-1841
Mailing Address330 Seven Springs WayBrentwood, TN 37027-5098 · (615) 920-7780
Phone(270) 236-3337
Fax(270) 236-3340
Organization SubpartNo
Authorized OfficialCharlotte LawrenceSecretary · (615) 920-7688
Enumeration DateJune 5, 2019
Last NPPES UpdateJuly 16, 20264 updates tracked since enumeration
NPPES CertifiedJuly 16, 2026
✔ NPI 1205494085 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Rural HealthAmbulatory Health Care Facilities
Taxonomy Code261QR1300X
2003 S 7TH ST, Hickman, KY 42050
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Other Names 1

Doing Business AsJackson Purchase Primary Care Hickman Clinic

Other Providers at the Same Location NPPES 8

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

PARKWAY REGIONAL MEDICAL CLINIC, INC
Clinic/Center (Rural Health)
2003 S 7TH ST
HICKMAN, KY 42050
Fulton County (270) 236-3202
HOSPITAL OF FULTON, INC.
Clinic/Center (Rural Health)
2003 S 7TH ST
HICKMAN, KY 42050
Fulton County (270) 236-3202
CHRISTY BYASSEE APRN, FNP-C
Nurse Practitioner (Family)
2003 S 7TH ST
HICKMAN, KY 42050
Fulton County (270) 236-3337
DR. DAISY MAY GAMOTIN BENIGNO M.D.
Family Medicine
2003 S 7TH ST
HICKMAN, KY 42050
Fulton County (270) 236-3202
DR. ASHOK KUMAR REDDY CHADA M.D
Family Medicine
2003 S 7TH ST
HICKMAN, KY 42050
Fulton County (270) 236-3202
HOSPITAL OF FULTON INC
Family Medicine
2003 S 7TH ST
HICKMAN, KY 42050
Fulton County (270) 236-3202
BRANDI L STACY APRN
Nurse Practitioner
2003 S 7TH ST
HICKMAN, KY 42050
Fulton County (270) 236-3337
ALLIE ALEXANDER-LUSK APRN
Nurse Practitioner (Family)
2003 S 7TH ST
HICKMAN, KY 42050
Fulton County (270) 236-3337

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Pinelake Physician Practice LLC's NPI number?

The NPI number for Pinelake Physician Practice LLC is 1205494085. It was assigned to this organization in the NPPES registry on June 5, 2019. The provider is doing business as Jackson Purchase Primary Care Hickman Clinic.

Where is Pinelake Physician Practice LLC located?

Pinelake Physician Practice LLC is located at 2003 S 7th St, Hickman, KY 42050. The listed phone number is (270) 236-3337.

What is Pinelake Physician Practice LLC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Rural Health, with taxonomy code 261QR1300X.

When was this NPI record last updated?

The NPPES record for Pinelake Physician Practice LLC was last updated on July 16, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.