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General NPI Number Information
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NPI Number | 1750665162
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Entity Type | Organization
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Legal Business Name | CARRICO CONGLETON FAMILY PRACTICE, LLC
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Dates
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Enumeration Date | 10/04/2011
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Last Update Date | 02/21/2019
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Provider Practice Location Address
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Address Line | 2811 NEW HARTFORD ROAD SUITE B
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City | OWENSBORO
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State | KY
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Zip | 42303-1320
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Country | US
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Telephone | 270-215-0234
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Fax | 270-215-0316
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Provider Business Mailing Address
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Address Line | 2811 NEW HARTFORD RD STE B
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City | OWENSBORO
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State | KY
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Zip | 42303-1384
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Country | US
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Telephone | 270-215-0234
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Fax | 270-215-0316
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Authorized Official
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Title or Position | OWNER
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Name | JUDY A CARRICO
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Credential | APRN
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Telephone | 270-215-0234
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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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