Healthcare Provider Details

I. General information

NPI: 1295949667
Provider Name (Legal Business Name): FAMILY CARE OF NORTHERN KENTUCKY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 10/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 THOMAS MORE PKWY STE 203
EDGEWOOD KY
41017-5102
US

IV. Provider business mailing address

830 THOMAS MORE PKWY STE 203
EDGEWOOD KY
41017-5102
US

V. Phone/Fax

Practice location:
  • Phone: 859-341-5757
  • Fax: 859-331-4757
Mailing address:
  • Phone: 859-341-5757
  • Fax: 859-331-4757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: WECKENBROCK P GREGORY
Title or Position: PARTNER
Credential: MD
Phone: 859-341-5757