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General NPI Number Information
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NPI Number | 1568614543
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Entity Type | Organization
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Legal Business Name | FAMILY HEALTH CARE ASSOCIATES OF WILLIAMSBURG
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Dates
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Enumeration Date | 10/21/2008
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Last Update Date | 12/23/2009
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Provider Practice Location Address
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Address Line | 965 SOUTH HWY 25 STE 52
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City | WILLIAMSBURG
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State | KY
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Zip | 40769
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Country | US
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Telephone | 606-549-8780
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Fax | 606-549-8779
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Provider Business Mailing Address
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Address Line | P.O. BOX 1535
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City | BARBOURVILLE
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State | KY
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Zip | 40906
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Country | US
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Telephone | 606-549-8780
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Fax | 606-549-8779
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Authorized Official
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Title or Position | CLINIC OWNER
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Name | MS. GINA LYNN GOOD
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Credential | ARNP
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Telephone | 605-546-7777
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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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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 3568P
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License Number State | KY
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