Pinelake Physician Practice LLC
Pinelake Physician Practice LLC is a healthcare organization registered as Rural Health Clinic/Center in Hickman, KY, holding Type 2 (organization) NPI 1205494085 since 2019. The authorized official on file is Terrance Dillon, Assistant Secretary.
✓ Active NPI ✓ Valid NPI checksum
| NPI | 1205494085 |
|---|---|
| Entity type | Organization (Type 2) |
| Legal business name | Pinelake Physician Practice LLC |
| Other name | <Unavail> |
| Practice address | 2003 S 7TH ST, Hickman, KY, 42050 |
| Phone | 2702363337 |
| Fax | 2702363340 |
| Enumeration date | 2019-06-05 |
| Last updated in NPPES | 2022-08-24 |
Authorized official
| Name | Terrance Dillon |
|---|---|
| Title | Assistant Secretary |
| Phone | 5025967220 |
Taxonomy & classification
| Taxonomy code | Specialty | Primary | License | State |
|---|---|---|---|---|
| 261QR1300X | Rural Health Clinic/Center | Primary | — | — |
Copy-ready billing details
Provider: Pinelake Physician Practice LLC NPI: 1205494085 Taxonomy: 261QR1300X (Rural Health Clinic/Center) Address: 2003 S 7TH ST, Hickman, KY, 42050
Providers at this address
| NPI | Name | Type | Specialty | Location |
|---|---|---|---|---|
| 1245208875 | Hospital of Fulton, Inc. | Organization | Rural Health Clinic/Center | Hickman, KY |
| 1831139054 | Allie Alexander-Lusk | Individual | Family Nurse Practitioner | Hickman, KY |
| 1669696969 | Hospital of Fulton Inc | Organization | Family Medicine Physician | Hickman, KY |
| 1528228046 | Daisy Benigno | Individual | Family Medicine Physician | Hickman, KY |
| 1659504413 | Ashok Kumar Chada | Individual | Family Medicine Physician | Hickman, KY |
| 1760722144 | Brandi Stacy | Individual | Nurse Practitioner | Hickman, KY |
| 1043603137 | Parkway Regional Medical Clinic, Inc | Organization | Rural Health Clinic/Center | Hickman, KY |
| 1477120129 | Christy Byassee | Individual | Family Nurse Practitioner | Hickman, KY |
Verify this record
Cross-check NPI 1205494085 against the authoritative CMS record: view Pinelake Physician Practice LLC on the official NPPES registry .
What is an NPI number?
A National Provider Identifier (NPI) is a unique 10-digit number that CMS assigns to every U.S. healthcare provider and organization under HIPAA. Type 1 NPIs identify individual providers; Type 2 NPIs identify organizations. The NPI appears on insurance claims, prescriptions, and credentialing paperwork, and never changes — even if the provider moves or changes specialty. Read the full guide or validate an NPI number.
Frequently asked questions
What type of organization is Pinelake Physician Practice LLC?
What is a Type 2 NPI?
Source: CMS NPPES (public data). Snapshot 2026-07-11. Provider record last updated 2022-08-24.