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General NPI Number Information
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NPI Number | 1376188276
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Entity Type | Organization
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Legal Business Name | HEALTHCORE FAMILY PRACTICE, PLLC
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Dates
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Enumeration Date | 11/14/2019
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Last Update Date | 11/14/2019
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Provider Practice Location Address
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Address Line | 103 BOSTON SQ
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City | GEORGETOWN
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State | KY
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Zip | 40324-9746
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Country | US
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Telephone | 859-619-5488
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Fax | 502-570-9269
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Provider Business Mailing Address
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Address Line | 107 BROADBILL CT
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City | GEORGETOWN
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State | KY
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Zip | 40324-9294
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Country | US
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Telephone | 859-619-5488
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Fax | 502-570-9269
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Authorized Official
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Title or Position | APRN/PRESIDENT
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Name | BARBARA BAKER
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Credential | APRN
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Telephone | 859-619-5488
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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