Healthcare Provider Details

I. General information

NPI: 1851663991
Provider Name (Legal Business Name): TLC FAMILY PRACTICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2012
Last Update Date: 11/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26317 HIGHWAY 119 NORTH
BELFRY KY
41514-7417
US

IV. Provider business mailing address

P.O. BOX 843
BELFRY KY
41514-7417
US

V. Phone/Fax

Practice location:
  • Phone: 606-353-6926
  • Fax: 606-353-6928
Mailing address:
  • Phone: 606-353-6926
  • Fax: 606-353-6928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. NANCY K. CLAY
Title or Position: APRN
Credential: APRN, BC
Phone: 606-353-6926