Healthcare Provider Details

I. General information

NPI: 1063809523
Provider Name (Legal Business Name): FH&L FAMILY PRACTICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2015
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 SARTIN DR
EDMONTON KY
42129-8170
US

IV. Provider business mailing address

PO BOX 26
EDMONTON KY
42129-0026
US

V. Phone/Fax

Practice location:
  • Phone: 270-670-5960
  • Fax:
Mailing address:
  • Phone: 270-432-2444
  • Fax: 270-432-2445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ANGELA JESSIE
Title or Position: OWNER
Credential: APRN
Phone: 270-432-2444