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General NPI Number Information
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NPI Number | 1477844835
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Entity Type | Organization
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Legal Business Name | LIBERTY MEDICAL CLINIC
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Dates
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Enumeration Date | 04/20/2011
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Last Update Date | 10/29/2013
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Provider Practice Location Address
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Address Line | 108 TAYLOR ST
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City | LIBERTY
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State | KY
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Zip | 42539-3160
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Country | US
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Telephone | 606-706-4265
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Fax | 606-706-4275
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Provider Business Mailing Address
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Address Line | 108 TAYLOR ST P.O. BOX 1196
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City | LIBERTY
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State | KY
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Zip | 42539-3160
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Country | US
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Telephone | 606-706-4265
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Fax | 606-706-4275
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Authorized Official
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Title or Position | NURSE PRACTITIONER/OWNER
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Name | VICKIE L MARPLE
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Credential | APRN-F
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Telephone | 606-706-4265
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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 | 3004478
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License Number State | KY
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