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General NPI Number Information
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NPI Number | 1720092240
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Entity Type | Organization
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Legal Business Name | OWENSBORO PEDIATRICS LLC
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Dates
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Enumeration Date | 07/28/2006
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Last Update Date | 11/19/2024
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Provider Practice Location Address
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Address Line | 2200 E PARRISH AVE BLDG B SUITE 101
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City | OWENSBORO
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State | KY
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Zip | 42303
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Country | US
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Telephone | 270-683-3232
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Fax | 270-852-1600
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Provider Business Mailing Address
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Address Line | 2200 E PARRISH AVE BLDG B SUITE 101
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City | OWENSBORO
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State | KY
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Zip | 42303
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Country | US
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Telephone | 270-683-3232
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Fax | 270-852-1600
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | WILLIAM LOYD BUCK
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Credential |
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Telephone | 270-683-3232
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #5
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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 #6
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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