MEDICARE: FAMILY PRACTICE CLINIC OF BOONEVILLE, INC.

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	207Q00000X	Family Medicine Physician
2	261QR1300X	Rural Health Clinic/Center

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	:	1326152109
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY PRACTICE CLINIC OF BOONEVILLE, INC.

Provider Business Mailing Address
First Line	:	PO BOX 737
Second Line	:	200 MULBERRY STREET, SUITE A
City	:	BOONEVILLE
State	:	KY
Zip	:	41314-0737
Country	:	US
Telephone Number	:	606-593-6023
Fax Number	:	606-593-6087

Provider Business Practice Location Address
First Line	:	200 MULBERRY ST
Second Line	:	SUITE A
City	:	BOONEVILLE
State	:	KY
Zip	:	41314-7505
Country	:	US
Telephone Number	:	606-593-6023
Fax Number	:	606-593-6087

Authorized Official
Title or Position	:	OWNER OPERATOR
Name	:	KIM COX
Credential	:	APRN
Telephone Number	:	606-593-6023

Provider Enumeration Date	:	08/18/2006
Last Update Date	:	12/22/2015

Similar Medicare Providers

1326498338 — MRS. KRISTINA MICHELLE BYRD APRN, FNP-C
Practice Location Address:

200 MULBERRY ST
BOONEVILLE, KY
41314-7505

Practice Phone: 606-593-6023
Practice Fax: 606-593-6087

1932652096 — JOANNE COMBS
Practice Location Address:

200 MULBERRY ST STE A
BOONEVILLE, KY
41314-7505

Practice Phone: 606-593-6023
Practice Fax:

1528882636 — JOHNNA LEIGH GAY PMHNP
Practice Location Address:

200 MULBERRY ST STE A
BOONEVILLE, KY
41314-7505

Practice Phone: 606-593-6023
Practice Fax: 606-593-6087

1124826003 — ANGEL RENEE BIRCH LPCC
Practice Location Address:

200 MULBERRY ST STE A
BOONEVILLE, KY
41314-7505

Practice Phone: 606-593-6023
Practice Fax:

1427948355 — BARBARA FAYE ROBERTS FNP APRN
Practice Location Address:

200 MULBERRY ST STE A
BOONEVILLE, KY
41314-7505

Practice Phone: 606-593-6023
Practice Fax:

1245189810 — MAKALA NICOLE MARSHALL
Practice Location Address:

300 KY 1768
BOONEVILLE, KY
41314-7013

Practice Phone: 606-233-6654
Practice Fax:

Directions to “FAMILY PRACTICE CLINIC OF BOONEVILLE, INC. ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.