Healthcare Provider Details

I. General information

NPI: 1255009379
Provider Name (Legal Business Name): EDWIN HANCOCK APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2021
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1297 THOMPSON DR
BEAVER DAM KY
42320-9177
US

IV. Provider business mailing address

PO BOX 331
HARTFORD KY
42347-0331
US

V. Phone/Fax

Practice location:
  • Phone: 270-291-5165
  • Fax: 833-468-4881
Mailing address:
  • Phone: 270-291-5165
  • Fax: 833-468-4881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3016618
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number3016618
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: