Main Street Medical Clinic

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

Legal business name

MAIN STREET MEDICAL CLINIC

Practice address

107 E Main St
Grayson, KY 41143-1301

Phone

(606) 474-0244

Fax

(606) 474-0412

NPI assigned

Sep 25, 2023

Last updated

Sep 25, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Stacy Holley, APRNNPI 1144647652

Title

Owner

Phone

(606) 474-0244

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in KY

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Stacy Holley, FNP

  • Family Nurse Practitioner
  • Grayson, KY
  • NPI 1144647652
  Medicare reassignment Care Compare group NPD Authorized official
• Victoria Renee Gilliam, APRN

  • Family Nurse Practitioner
  • Grayson, KY
  • NPI 1326786146
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1695600000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1695600000000",
    "number": "1952180408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 E MAIN ST",
            "city": "GRAYSON",
            "state": "KY",
            "postal_code": "411431301",
            "telephone_number": "606-474-0244",
            "fax_number": "606-474-0412"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 E MAIN ST",
            "city": "GRAYSON",
            "state": "KY",
            "postal_code": "411431301",
            "telephone_number": "606-474-0244",
            "fax_number": "606-474-0412"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAIN STREET MEDICAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-09-25",
        "last_updated": "2023-09-25",
        "certification_date": "2023-09-25",
        "status": "A",
        "authorized_official_last_name": "HOLLEY",
        "authorized_official_first_name": "STACY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "606-474-0244",
        "authorized_official_credential": "APRN"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Little Sandy District Health Dept
• Heath Avery Logue, LCSW
• Kelsey Lucas
• Brittany Ludwig
• Callie Mabry, PT, DPT
• Maranda Manns, OT
• Kara Marsh
• Thomas Lee Mattingly, RPH
• Johnny Mauk
• Greg Matthew Mayhorn

• Family Nurse Practitioner in Grayson, KY
• Providers in Grayson, KY by specialty
• Family Nurse Practitioner in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.