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General NPI Number Information
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NPI Number | 1265909121
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Entity Type | Organization
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Legal Business Name | ROCKCASTLE RIVER FAMILY HEALTH CLINIC PLLC
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Dates
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Enumeration Date | 10/30/2018
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Last Update Date | 10/30/2018
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Provider Practice Location Address
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Address Line | 9226 MAIN ST
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City | LIVINGSTON
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State | KY
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Zip | 40445
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Country | US
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Telephone | 606-453-3901
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Fax |
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Provider Business Mailing Address
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Address Line | 502 S UPPER RIVER RD
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City | LIVINGSTON
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State | KY
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Zip | 40445-8743
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Country | US
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Telephone | 606-453-3901
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DAWN CARPENTER
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Credential | APRN
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Telephone | 606-453-3901
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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 |
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License Number State |
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