Healthcare Provider Details

I. General information

NPI: 1750557302
Provider Name (Legal Business Name): FREEMAN FAMILY PRACTICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2008
Last Update Date: 05/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10755 N US HIGHWAY 25E
GRAY KY
40734-6529
US

IV. Provider business mailing address

10755 N US HIGHWAY 25E
GRAY KY
40734-6529
US

V. Phone/Fax

Practice location:
  • Phone: 606-258-8050
  • Fax: 606-258-8994
Mailing address:
  • Phone: 606-258-8050
  • Fax: 606-258-8050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2597P
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number900220
License Number StateKY

VIII. Authorized Official

Name: TAMMY L FREEMAN
Title or Position: OWNER
Credential: ARNP
Phone: 606-258-8050