Healthcare Provider Details

I. General information

NPI: 1770813495
Provider Name (Legal Business Name): SEBREE CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2009
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7139 HWY 56 E
SEBREE KY
42455
US

IV. Provider business mailing address

7139 HWY 56 E
SEBREE KY
42455
US

V. Phone/Fax

Practice location:
  • Phone: 270-835-2200
  • Fax: 270-835-2204
Mailing address:
  • Phone: 270-835-2200
  • Fax: 270-835-2204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3510P
License Number StateKY

VIII. Authorized Official

Name: MS. CONNIE J SKINNER
Title or Position: SOLE OWNER
Credential: ARNP
Phone: 270-835-2200