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General NPI Number Information
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NPI Number | 1851054597
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Entity Type | Organization
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Legal Business Name | KENTUCKY FAMILY PRACTICE INC
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Dates
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Enumeration Date | 10/19/2021
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Last Update Date | 10/26/2021
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Provider Practice Location Address
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Address Line | 195 COMMERCIAL DR STE 98
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City | LONDON
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State | KY
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Zip | 40744-5200
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Country | US
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Telephone | 606-878-1219
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Fax |
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Provider Business Mailing Address
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Address Line | 195 COMMERCIAL DR STE 98
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City | LONDON
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State | KY
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Zip | 40744-5200
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Country | US
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Telephone | 606-878-1219
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ERIC EVANS
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Credential |
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Telephone | 606-878-1219
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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