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General NPI Number Information
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NPI Number | 1134264799
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Entity Type | Organization
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Legal Business Name | ROCKCASTLE VENTURES INC. DOING BUSINESS AS ROCKCASTLE CLINIC
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Dates
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Enumeration Date | 02/21/2007
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Last Update Date | 06/22/2010
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Provider Practice Location Address
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Address Line | 140 NEWCOMB AVE
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City | MOUNT VERNON
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State | KY
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Zip | 40456-2728
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Country | US
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Telephone | 606-256-5176
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Fax | 606-256-4401
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Provider Business Mailing Address
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Address Line | 140 NEWCOMB AVE
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City | MOUNT VERNON
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State | KY
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Zip | 40456-2728
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Country | US
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Telephone | 606-256-5176
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Fax | 606-256-4401
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Authorized Official
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Title or Position | DIRECTOR
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Name | BRANDY L. BULLOCK
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Credential |
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Telephone | 606-256-7761
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 39587
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 64035884
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA861
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License Number State | KY
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Taxonomy #5
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 4217P
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License Number State | KY
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Taxonomy #6
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 25335
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License Number State | KY
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