Healthcare Provider Details

I. General information

NPI: 1811153323
Provider Name (Legal Business Name): JEFFERSONVILLE FAMILY CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2008
Last Update Date: 08/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9070 MAIN STREET
JEFFERSONVILLE KY
40337
US

IV. Provider business mailing address

9070 MAIN ST SUITE 2
JEFFERSONVILLE KY
40337
US

V. Phone/Fax

Practice location:
  • Phone: 859-513-0416
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number5403P
License Number StateKY

VIII. Authorized Official

Name: MRS. DEBORAH ALISON CROWE
Title or Position: ARNP/OWNER
Credential: FNP-BC
Phone: 859-513-0416