Healthcare Provider Details

I. General information

NPI: 1780824763
Provider Name (Legal Business Name): FAMILY HEALTH CARE ASSOCIATES OF SOMERSET PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2009
Last Update Date: 08/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 LANGDON STREET SUITE B
SOMERSET KY
42501
US

IV. Provider business mailing address

PO BOX 1535
BARBOURVILLE KY
40906-5535
US

V. Phone/Fax

Practice location:
  • Phone: 606-546-7777
  • Fax: 606-545-7611
Mailing address:
  • Phone: 606-546-7777
  • Fax: 606-545-7611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. GINA GOOD
Title or Position: ARNP/OWNER
Credential:
Phone: 606-546-7777