Main Street Family Medicine, LLC
Nurse Practitioner, Family in Whitesville, KY. Organization (NPI-2).
NPI number1528097433
StatusActive
Last updated in NPPESMar 21, 2022
Details
- NPI
- 1528097433
- Entity type
- Organization (NPI-2)
- Legal business name
- Main Street Family Medicine, LLC
- Organization subpart
- No
- Enumeration date
- Jul 2, 2006
- Certification date
- Mar 21, 2022
- Last updated
- Mar 21, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LF0000X | Nurse Practitioner, Family | 2848P | KY | Yes |
| 363A00000X | Physician Assistant | – | – | |
| 363LF0000X | Nurse Practitioner, Family | – | – |
Practice location
10015 Main StWhitesville, KY 42378-9557
Phone 270-233-1884 · Fax 270-233-9520
Mailing address
10015 Main StWhitesville, KY 42378-9557
Phone 270-233-1884 · Fax 270-233-9520
Other practice locations
2429 W Parrish Ave # 3
Owensboro, KY 42301-2661
Owensboro, KY 42301-2661
Phone 270-215-0325
Authorized official
Cynthia Dianne Glenn-Birkhead
Owner
2702331884
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