PINELAKE PHYSICIAN PRACTICE LLC
NPI 1205494085
Clinic/Center - Rural Health in Hickman, KY
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 holds a CLIA Waiver certificate valid through December 16, 2027 and lists Charlotte Lawrence, Secretary, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Names 1
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 18D2106420
Jackson Purchase Primary Care Hickman Clinic · Hickman, KYOther Providers at the Same Location NPPES 8
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
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.
Does Pinelake Physician Practice LLC hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 18D2106420) is associated with this NPI, valid through December 16, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
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 with the weekly NPPES data releases published by CMS.
