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General NPI Number Information
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NPI Number | 1780106591
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Entity Type | Organization
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Legal Business Name | ELKHORN PRIMARY CARE
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Dates
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Enumeration Date | 07/13/2017
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Last Update Date | 07/13/2017
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Provider Practice Location Address
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Address Line | 112 E MAIN ST
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City | ELKHORN CITY
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State | KY
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Zip | 41522-9043
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Country | US
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Telephone | 606-754-5793
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Fax | 606-886-9908
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Provider Business Mailing Address
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Address Line | P.O. BOX 1432
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City | ELKHORN CITY
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State | KY
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Zip | 41522-9043
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Country | US
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Telephone | 606-754-5793
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Fax | 606-886-9908
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Authorized Official
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Title or Position | OWNER
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Name | CRYSTAL BRANHAM
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Credential | NP
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Telephone | 606-754-5793
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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 | 3007228
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License Number State | KY
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