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General NPI Number Information
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NPI Number | 1225593346
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Entity Type | Organization
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Legal Business Name | ADVANCED FAMILY CLINIC
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Dates
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Enumeration Date | 02/02/2019
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Last Update Date | 02/02/2019
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Provider Practice Location Address
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Address Line | 1619 FOXHAVEN DR # 1617
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City | RICHMOND
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State | KY
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Zip | 40475-1056
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Country | US
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Telephone | 859-661-1930
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 279
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City | RICHMOND
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State | KY
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Zip | 40476-0279
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Country | US
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Telephone | 859-661-1930
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | HEATHER MCCLURE
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Credential | APRN
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Telephone | 859-353-9062
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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