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General NPI Number Information
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NPI Number | 1134122468
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Entity Type | Organization
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Legal Business Name | CORBIN FAMILY PRACTICE CLINIC, INC.
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Dates
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Enumeration Date | 05/31/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1400 CUMBERLAND FALLS HWY STE C
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City | CORBIN
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State | KY
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Zip | 40701-2739
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Country | US
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Telephone | 606-258-8787
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Fax | 606-258-8788
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Provider Business Mailing Address
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Address Line | PO BOX 1125
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City | CORBIN
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State | KY
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Zip | 40702-1125
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Country | US
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Telephone | 606-528-0283
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Fax | 606-528-8422
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Authorized Official
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Title or Position | PRESIDENT
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Name | ROBERT A. CARTER JR.
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Credential |
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Telephone | 606-528-0283
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 2774P
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License Number State | KY
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