MEDICARE: CRICK AND FIFE, LLP

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	363LP0200X	Pediatric Nurse Practitioner

General Provider Information

NPI Number	:	1174896609
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRICK AND FIFE, LLP

Provider Business Mailing Address
First Line	:	110 3RD ST STE 180
Second Line	:
City	:	HENDERSON
State	:	KY
Zip	:	42420-5808
Country	:	US
Telephone Number	:	270-827-3573
Fax Number	:	270-827-1250

Provider Business Practice Location Address
First Line	:	110 3RD ST STE 180
Second Line	:
City	:	HENDERSON
State	:	KY
Zip	:	42420-5808
Country	:	US
Telephone Number	:	270-827-3573
Fax Number	:	270-827-1250

Authorized Official
Title or Position	:	OWNER
Name	:	DR. LARRY CRICK
Credential	:	M.D.,F.A.A.P.
Telephone Number	:	270-827-3573

Provider Enumeration Date	:	02/14/2012
Last Update Date	:	02/14/2012

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