Healthcare Provider Details

I. General information

NPI: 1174973705
Provider Name (Legal Business Name): COPPER CREEK MIDWIFERY & FAMILY PRACTICE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2016
Last Update Date: 06/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 S 4TH ST
DANVILLE KY
40422-2085
US

IV. Provider business mailing address

960 EDWARDS RD
CRAB ORCHARD KY
40419-9610
US

V. Phone/Fax

Practice location:
  • Phone: 859-475-3915
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3007732
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number3007867
License Number StateKY

VIII. Authorized Official

Name: CHRISTINA SCRIBNER
Title or Position: OWNER; APRN
Credential: APRN
Phone: 859-475-3915