Healthcare Provider Details

I. General information

NPI: 1194103937
Provider Name (Legal Business Name): EPHRAIM MCDOWELL HEALTH RESOURCE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2015
Last Update Date: 01/14/2026
Certification Date: 01/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 W MAIN ST STE 102
DANVILLE KY
40422-1871
US

IV. Provider business mailing address

230 W MAIN ST STE 102
DANVILLE KY
40422-1872
US

V. Phone/Fax

Practice location:
  • Phone: 859-236-9670
  • Fax: 859-236-7656
Mailing address:
  • Phone: 859-236-9670
  • Fax: 859-236-7656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. AMANDA KINMAN
Title or Position: CFO
Credential:
Phone: 859-239-2424