Nra-Princeton, Kentucky, LLC

Primary specialty

End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X

License

300151 Issued in KY

Legal business name

NRA-PRINCETON, KENTUCKY, LLC

Practice address

401 S Jefferson St
Princeton, KY 42445-2113

Phone

(270) 365-7588

Fax

(270) 365-7586

NPI assigned

Jan 13, 2006

Organization subpart

Yes

Parent organization

FRESENIUS MEDICAL CARE HOLDINGS, INC.As reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Barry L. Blanton

Title

Vice President

Phone

(781) 699-9000

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• CALDWELL COUNTY DIALYSIS CLINIC Doing business as

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• National Medical Care, Inc.

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Bristol, TN
  • NPI 1477570117

  Member Of

  NPD member

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1137110400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1628208000000",
    "number": "1154300564",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 S JEFFERSON ST",
            "city": "PRINCETON",
            "state": "KY",
            "postal_code": "424452113",
            "telephone_number": "270-365-7588",
            "fax_number": "270-365-7586"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 S JEFFERSON ST",
            "city": "PRINCETON",
            "state": "KY",
            "postal_code": "424452113",
            "telephone_number": "270-365-7588",
            "fax_number": "270-365-7586"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NRA-PRINCETON, KENTUCKY, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FRESENIUS MEDICAL CARE HOLDINGS, INC.",
        "enumeration_date": "2006-01-13",
        "last_updated": "2021-08-06",
        "certification_date": "2021-08-06",
        "status": "A",
        "authorized_official_last_name": "BLANTON",
        "authorized_official_first_name": "BARRY",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "781-699-9000"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "KY",
            "license": "300151",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA CERT OF WAIVER",
            "identifier": "18D1004814",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "39000534",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CALDWELL COUNTY DIALYSIS CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Stephanie L Mundy, APRN
• Anna Murphy, DNP, APRN, FNP-BC
• Ellery H. Naghtin, APRN
• Sarena Newberry
• Michelle Lynn Nichols
• Amber Lynn O'Hearn, FNP-C
• David Lee Oliver, DMD
• Orr Medical, LLC .
• Amanda Grace Ortt, M.ED., LPCC, NCC
• Linda Ortt, COTA/L

• All providers in Princeton, KY
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.