Active NPI
Commonwealth Community Care Centers, LLC
- Procedural Dermatology Physician
- Prestonsburg, KY
National Provider Identifier
1568094670
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Procedural Dermatology Physician
- Legal business name
- COMMONWEALTH COMMUNITY CARE CENTERS, LLC
- Practice address
- 154 N Lake Dr
Prestonsburg, KY 41653-1270 - Phone
- (606) 506-5093
- Fax
- (606) 506-5039
- NPI assigned
- Feb 6, 2020
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mrs. Yvette Wisener, CPC
- Title
- Billing
- Phone
- (256) 258-9603
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Procedural Dermatology Physician | 207NS0135X | Primary | ||
| Obstetrics & Gynecology Physician | 207V00000X | |||
| Family Nurse Practitioner | 363LF0000X |
Addresses
Primary practice location
154 N Lake Dr
Prestonsburg, KY 41653-1270
Mailing address
156 North Lake Drive
Prestonburg, KY 41653
Phone (606) 506-5093
Other practice location 1
4010 DuPont Cir Ste 370
Louisville, KY 40207-4881
Phone (606) 263-4283
Other practice location 2
601 N Shore Dr Ste 203
Jeffersonville, IN 47130-3145
Phone (606) 263-4283
Other practice location 3
2008 Merchant Dr
Richmond, KY 40475-8188
Phone (606) 263-4283
National Provider Directory
National Provider DirectoryLocations
156 N Lake Dr
Prestonsburg, KY 41653
Phone (606) 506-5093
2008 Merchant Dr
Richmond, KY 40475
Phone (606) 263-4283
Practitioners 8
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Obstetrics & Gynecology Physician
- Louisville, KY
- NPI 1285703454
Obstetrics & Gynecology
-
- Neuromusculoskeletal Medicine & OMM Physician
- Lynchburg, VA
- NPI 1619453206
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 18D2196777 | Commonwealth Community Care Centers | Certificate of waiver | Oct 19, 2026 |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1580947200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1662076800000",
"number": "1568094670",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "156 NORTH LAKE DRIVE",
"city": "PRESTONBURG",
"state": "KY",
"postal_code": "41653",
"telephone_number": "606-506-5093",
"fax_number": "606-506-5039"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "154 N LAKE DR",
"city": "PRESTONSBURG",
"state": "KY",
"postal_code": "416531270",
"telephone_number": "606-506-5093",
"fax_number": "606-506-5039"
}
],
"practiceLocations": [
{
"address_1": "4010 DuPont Cir Ste 370",
"address_purpose": "LOCATION",
"city": "Louisville",
"state": "KY",
"postal_code": "402074881",
"country_code": "US",
"telephone_number": "606-263-4283",
"fax_number": "606-263-4285",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "601 N Shore Dr Ste 203",
"address_purpose": "LOCATION",
"city": "Jeffersonville",
"state": "IN",
"postal_code": "471303145",
"country_code": "US",
"telephone_number": "606-263-4283",
"fax_number": "606-263-4285",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "2008 Merchant Dr",
"address_purpose": "LOCATION",
"city": "Richmond",
"state": "KY",
"postal_code": "404758188",
"country_code": "US",
"telephone_number": "606-263-4283",
"fax_number": "606-263-4285",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"organization_name": "COMMONWEALTH COMMUNITY CARE CENTERS, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2020-02-06",
"last_updated": "2022-09-02",
"certification_date": "2022-09-02",
"status": "A",
"authorized_official_last_name": "WISENER",
"authorized_official_first_name": "YVETTE",
"authorized_official_title_or_position": "BILLING",
"authorized_official_telephone_number": "256-258-9603",
"authorized_official_name_prefix": "Mrs.",
"authorized_official_credential": "CPC"
},
"taxonomies": [
{
"code": "207NS0135X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Dermatology, Procedural Dermatology",
"state": null,
"license": null,
"primary": true
},
{
"code": "207V00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Obstetrics & Gynecology",
"state": null,
"license": null,
"primary": false
},
{
"code": "363LF0000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Nurse Practitioner, Family",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Prestonsburg, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.