Healthcare Provider Details

I. General information

NPI: 1346323383
Provider Name (Legal Business Name): PHYSICIANS FOR FAMILIES PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 PORTMAN AVE
STANFORD KY
40484-1230
US

IV. Provider business mailing address

126 PORTMAN AVE
STANFORD KY
40484-1230
US

V. Phone/Fax

Practice location:
  • Phone: 606-365-9181
  • Fax: 606-365-9183
Mailing address:
  • Phone: 606-365-9181
  • Fax: 606-365-9183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number17220
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. KAREN CLICK
Title or Position: OFFICE MANAGER
Credential:
Phone: 606-365-9181