Healthcare Provider Details

I. General information

NPI: 1619880408
Provider Name (Legal Business Name): MODERN ROOTS HEALTHCARE,PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 WABASH RD
UPTON KY
42784-9222
US

IV. Provider business mailing address

1140 WABASH RD
UPTON KY
42784-9222
US

V. Phone/Fax

Practice location:
  • Phone: 270-766-7676
  • Fax: 270-246-9774
Mailing address:
  • Phone: 270-766-7676
  • Fax: 270-246-9774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. ABBY CARTER
Title or Position: OWNER
Credential: APRN
Phone: 270-766-7676