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General NPI Number Information
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NPI Number | 1245236900
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Entity Type | Organization
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Legal Business Name | BRECKINRIDGE HEALTH, INC.
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Dates
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Enumeration Date | 06/27/2005
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Last Update Date | 03/29/2017
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Provider Practice Location Address
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Address Line | 209 ELM ST
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City | CLOVERPORT
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State | KY
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Zip | 40111-1324
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Country | US
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Telephone | 270-788-3000
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Fax | 270-788-6201
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Provider Business Mailing Address
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Address Line | 209 ELM ST
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City | CLOVERPORT
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State | KY
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Zip | 40111-1324
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Country | US
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Telephone | 270-788-3000
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Fax | 270-788-6201
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | MRS. MANDY J BUTLER
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Credential | ARNP
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Telephone | 270-788-3000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 900053
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number | 900053
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License Number State | KY
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