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General NPI Number Information
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NPI Number | 1972979540
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Entity Type | Organization
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Legal Business Name | FAMILY PRACTICE OF KENTUCKY LLC
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Dates
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Enumeration Date | 08/18/2015
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Last Update Date | 10/03/2022
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Provider Practice Location Address
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Address Line | 21 CRESTVIEW DR
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City | MANCHESTER
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State | KY
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Zip | 40962-7012
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Country | US
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Telephone | 606-594-1769
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Fax | 606-596-0473
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Provider Business Mailing Address
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Address Line | 204 TOWN BRANCH RD
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City | MANCHESTER
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State | KY
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Zip | 40962-1322
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Country | US
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Telephone | 606-596-7196
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Fax | 606-598-1903
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Authorized Official
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Title or Position | OWNER
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Name | MRS. EVA A EDWARDS
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Credential | ARNP,FNP-BC,RFNA,CNO
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Telephone | 606-594-1769
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 900342
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License Number State | KY
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State | KY
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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 | KY
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Taxonomy #6
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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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