MEDICARE: FAMILY HEALTH CARE CLINIC PSC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	3002572	KY
2	261QR1300X	Rural Health Clinic/Center	900186	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073717286
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY HEALTH CARE CLINIC PSC

Provider Business Mailing Address
First Line	:	PO BOX 35
Second Line	:
City	:	RICHMOND
State	:	KY
Zip	:	40476-0035
Country	:	US
Telephone Number	:	859-626-9696
Fax Number	:

Provider Business Practice Location Address
First Line	:	312 JASON DR
Second Line	:	SUITE 9
City	:	RICHMOND
State	:	KY
Zip	:	40475-2785
Country	:	US
Telephone Number	:	859-626-9696
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KAY STEPHENS
Credential	:	APRN
Telephone Number	:	859-626-9696

Provider Enumeration Date	:	06/12/2007
Last Update Date	:	07/16/2014

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