Crab Orchard Family Practice Clinic, Inc.
Organization Active NPI Nurse Practitioner · Crab Orchard, KY
NPI 1033112362 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1033112362
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- 3630P (KY)
- Legal business name
- CRAB ORCHARD FAMILY PRACTICE CLINIC, INC.
- Practice address
- 207 Main St
Crab Orchard, KY 40419-9697 - Phone
- (606) 355-7300
- Fax
- (606) 355-7310
- NPI assigned
- May 31, 2005
- Organization subpart
- No
Authorized official
- Name
- Robert A. Carter Jr.
- Title
- President
- Phone
- (606) 528-0283
Corporate family (same tax ID) 1
National Provider Directory
- Tax ID family
- Crab Orchard Family Practice Clinic
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner |
363L00000X | 3630P | KY | Yes |
Addresses
Primary practice location
207 Main St
Crab Orchard, KY 40419-9697
Mailing address
PO Box 1125
Corbin, KY 40702-1125
Phone (606) 528-0283
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 35-001353 | Medicaid | KY |
Other providers in Crab Orchard, KY
- Heather Jones Adams
- Tammy Lee Baker
- Ashlyn E Boots
- Mattie A Byler
- Crab Orchard Family Practice Clinic
- Cumberland Family Medical Center Inc
- East End Ambulance Service Inc
- Jessica D Fletcher
- Lincoln County Health Department
- Karen McCoy
All providers in Crab Orchard, KY · Nurse Practitioner in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.