Healthcare Provider Details

I. General information

NPI: 1407149016
Provider Name (Legal Business Name): FAMILY HEALTH CARE ASSOCIATES OF KENTUCKY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2011
Last Update Date: 05/18/2023
Certification Date: 05/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

249 OLD US HIGHWAY 421 STE 2
MANCHESTER KY
40962-7506
US

IV. Provider business mailing address

PO BOX 1535
BARBOURVILLE KY
40906-5535
US

V. Phone/Fax

Practice location:
  • Phone: 606-599-0077
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: GINA GOOD
Title or Position: PRESIDENT
Credential: APRN
Phone: 606-546-7777