MEDICARE: HARRODSBURG FAMILY PRACTICE ASSOCIATES, LLC

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	3006711	KY
2	207R00000X	Internal Medicine Physician	KY31272	KY

General Provider Information

NPI Number	:	1659616126
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HARRODSBURG FAMILY PRACTICE ASSOCIATES, LLC

Provider Business Mailing Address
First Line	:	214 S CHILES ST
Second Line	:
City	:	HARRODSBURG
State	:	KY
Zip	:	40330-1631
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	214 S CHILES ST
Second Line	:
City	:	HARRODSBURG
State	:	KY
Zip	:	40330-1631
Country	:	US
Telephone Number	:	185-973-4278
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JENNIFER PELFREY
Credential	:
Telephone Number	:	160-666-9771

Provider Enumeration Date	:	12/10/2012
Last Update Date	:	12/10/2012

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