Healthcare Provider Details

I. General information

NPI: 1255221610
Provider Name (Legal Business Name): JAMES PATRICK CIVILLE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2025
Last Update Date: 07/09/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7409 US HIGHWAY 42
FLORENCE KY
41042-1905
US

IV. Provider business mailing address

8828 VALLEY CIRCLE DR
FLORENCE KY
41042-8228
US

V. Phone/Fax

Practice location:
  • Phone: 859-525-8181
  • Fax:
Mailing address:
  • Phone: 859-652-4716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4043620
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: