Healthcare Provider Details

I. General information

NPI: 1902242613
Provider Name (Legal Business Name): NANCY FAMILY PRACTICE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2013
Last Update Date: 07/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7238 W HIGHWAY 80
NANCY KY
42544-8752
US

IV. Provider business mailing address

PO BOX 100 7238 WEST HWY 80
NANCY KY
42544-0100
US

V. Phone/Fax

Practice location:
  • Phone: 606-636-4214
  • Fax: 606-636-4215
Mailing address:
  • Phone: 606-636-4214
  • Fax: 606-636-4215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number900330
License Number StateKY

VIII. Authorized Official

Name: MRS. DIANA L WILLIAMSON
Title or Position: COO/CO-OWNER/PROVIDER
Credential: APRN FNP-C
Phone: 606-636-4214