Bluegrass Clinic Liberty, PLLC
Organization Active NPI Family Medicine Physician · Liberty, KY
NPI 1457555146 · NPPES record last updated Oct 25, 2023
Key facts
- NPI
- 1457555146
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- BLUEGRASS CLINIC LIBERTY, PLLC
- Practice address
- 256 N Wallace Wilkinson Blvd
Liberty, KY 42539-3014 - Phone
- (160) 678-7001
- Fax
- (606) 787-0035
- NPI assigned
- Jun 14, 2007
- Organization subpart
- No
Authorized official
- Name
- Dr. James A Miller, M.D.
- Title
- Provider Owner
- Phone
- (606) 365-8338
Practitioners 11
-
Amanda Dee Brock, APRN
-
Crystal D Brown, ARNP
-
Jeremy David Caudill, PA-C
-
Kevin Crabtree, MSPAS, PA-C
-
Donna C Hankla, ARNP
-
Lucas J Kennedy, PA
-
Jillian Ann Miles, PA-C
-
Kevin Pettus, MD
-
Todd D Reinhart, MD
-
Heather Hoewing, PA-C
-
Hongjae Kim, M.D.
National Provider Directory
Locations
19 Abes Plz
Liberty, KY 42539
Phone 6063658338312
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes | ||
| Rural Health Clinic/Center | 261QR1300X |
Addresses
Primary practice location
256 N Wallace Wilkinson Blvd
Liberty, KY 42539-3014
Mailing address
256 N Wallace Wilkinson Blvd
Liberty, KY 42539-3014
Phone (606) 787-0014
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7100032530 | Medicaid | KY |
Other providers in Liberty, KY
- Christol Barnett
- Michele F Beeler
- Beyond the Label LLC
- Ashely Blevins
- Jolene Blevins
- Breece Wayne Hayes D.C., P.S.C.
- Lisa Buis
- Ashley E Cambron
- Aleta Cannon
- Tanya Carman
All providers in Liberty, KY · Family Medicine Physician in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 25, 2023. 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.