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General NPI Number Information
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NPI Number | 1801120498
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL FAMILY HEALTHCARE INC
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Dates
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Enumeration Date | 09/29/2009
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Last Update Date | 09/29/2009
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Provider Practice Location Address
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Address Line | 1632 CUMBERLAND AVE STE 7
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City | MIDDLESBORO
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State | KY
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Zip | 40965-1378
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Country | US
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Telephone | 606-248-7000
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Fax | 606-248-6699
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Provider Business Mailing Address
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Address Line | PO BOX 876 1632 CUMBERLAND AVENUE SUITE 7
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City | MIDDLESBORO
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State | KY
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Zip | 40965-0876
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Country | US
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Telephone | 606-248-7000
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Fax | 606-248-6699
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. CAROLYN M DAVIS
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Credential | ARNP
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Telephone | 606-248-7000
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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 | 5516P
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License Number State | KY
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