Healthcare Provider Details

I. General information

NPI: 1952334054
Provider Name (Legal Business Name): FAMILY CARE OF NORTHERN KENTUCKY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 09/21/2007
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 TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

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