NPIMap

Organization Active NPI

Family Care of Northern Kentucky, PLLC

  • Family Nurse Practitioner
  • Edgewood, KY
National Provider Identifier
1295949667
Registry record updated Oct 5, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
Legal business name
FAMILY CARE OF NORTHERN KENTUCKY, PLLC
Practice address
830 Thomas More Pkwy
Ste 203
Edgewood, KY 41017-5102
Phone
(859) 341-5757
Fax
(859) 331-4757
NPI assigned
May 9, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2007

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

Authorized official

Name
Weckenbrock P Gregory, MD
Title
Partner
Phone
(859) 341-5757

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LF0000X Primary

Addresses

Primary practice location

830 Thomas More Pkwy
Ste 203
Edgewood, KY 41017-5102

Mailing address

830 Thomas More Pkwy
Ste 203
Edgewood, KY 41017-5102
Phone (859) 341-5757

Other identifiers 1

IdentifierTypeStateIssuer
7100001950MedicaidKY

Other names 1

  • Premier Family Medicine Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1178668800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1191542400000",
    "number": "1295949667",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "830 THOMAS MORE PKWY",
            "address_2": "STE 203",
            "city": "EDGEWOOD",
            "state": "KY",
            "postal_code": "410175102",
            "telephone_number": "859-341-5757",
            "fax_number": "859-331-4757"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "830 THOMAS MORE PKWY",
            "address_2": "STE 203",
            "city": "EDGEWOOD",
            "state": "KY",
            "postal_code": "410175102",
            "telephone_number": "859-341-5757",
            "fax_number": "859-331-4757"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY CARE OF NORTHERN KENTUCKY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-09",
        "last_updated": "2007-10-05",
        "status": "A",
        "authorized_official_last_name": "GREGORY",
        "authorized_official_first_name": "WECKENBROCK",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "859-341-5757",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100001950",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Premier Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Edgewood, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2007; 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.