Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Pinelake Physician Practice LLC

Organization Otolaryngology/Facial Plastic Surgery Physician · NPI 1255650479

Pinelake Physician Practice LLC is an Otolaryngology/Facial Plastic Surgery Physician in Mayfield, Kentucky. Registered with an NPI since 2010.

In the registry since
2010
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

See every abbreviation used in this directory →

Practice location Address checks out

1111 Medical Center Cir
Mayfield, KY 42066-1194
Phone: (270) 251-4080
Fax: (270) 251-4081
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Otolaryngology/Facial Plastic Surgery Physician (primary) Taxonomy 207YX0905X

Record details

NPI number1255650479
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Timothy Vaughn — Vice President · (615) 372-8500
Other names Jackson Purchase Ent & Aesthetic Surgery
NPI enumeratedMay 27, 2010
Last updated in NPPESMay 27, 2010
Mailing address1029 Medical Center Cir, Mayfield, KY 42066-1189