Healthcare Provider Details

I. General information

NPI: 1912835976
Provider Name (Legal Business Name): PRIMARY PURPOSE PRIMARY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 ORCHARD DR
NICHOLASVILLE KY
40356-2690
US

IV. Provider business mailing address

125 ORCHARD DR
NICHOLASVILLE KY
40356-2690
US

V. Phone/Fax

Practice location:
  • Phone: 859-608-5906
  • Fax:
Mailing address:
  • Phone: 859-608-5906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: ANDREW RAY USERY
Title or Position: OWNER
Credential:
Phone: 859-608-5906