Healthcare Provider Details

I. General information

NPI: 1477781904
Provider Name (Legal Business Name): VALENCIA FAMILY PRACTICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2009
Last Update Date: 06/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3503 CUMBERLAND AVE
MIDDLESBORO KY
40965-2611
US

IV. Provider business mailing address

3503 CUMBERLAND AVE
MIDDLESBORO KY
40965-2611
US

V. Phone/Fax

Practice location:
  • Phone: 606-248-7920
  • Fax: 606-248-7947
Mailing address:
  • Phone: 606-248-7920
  • Fax: 606-248-7947

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. KRISTI M. PARTIN
Title or Position: C.E.O.
Credential:
Phone: 606-545-4866