NPIMap

Organization Active NPI

Family Practice of Kentucky LLC

  • Rural Health Clinic/Center
  • Manchester, KY
National Provider Identifier
1972979540
Registry record updated Oct 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
FAMILY PRACTICE OF KENTUCKY LLC
Practice address
21 Crestview Dr
Manchester, KY 40962-7012
Phone
(606) 594-1769
Fax
(606) 596-0473
NPI assigned
Aug 18, 2015
Last updated
Oct 3, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 3, 2022

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

Authorized official

Name
Mrs. Eva A Edwards, ARNP,FNP-BC,RFNA,CNONPI 1396964102
Title
Owner
Phone
(606) 594-1769

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YA0400X KY
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X 900342 KY
Multi-Specialty Clinic/Center 261QM1300X
Rural Health Clinic/Center 261QR1300X Primary
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X KY
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X KY

Addresses

Primary practice location

21 Crestview Dr
Manchester, KY 40962-7012

Mailing address

204 Town Branch Rd
Manchester, KY 40962-1322
Phone (606) 596-7196

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20161004000230 KY Part B Supplier - Clinic/Group Practice 2961790167 Receives reassigned benefits from 9 practitioners
Practice locations: Manchester, KY; Pineville, KY
O20180307002698 KY Part A Provider - Rural Health Clinic 2961790167 Practice locations: Manchester, KY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1972979540. Details of each certification follow.

Rural health clinic certification: CCN 188978

Legal name
FAMILY PRACTICE OF KENTUCKY LLC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jul 19, 2018
Last certification
Jul 19, 2018
Ownership / control type
1B
Organization structure
LLCProprietary
Incorporated
Aug 28, 2015 in KY
Enrollment address
21 Crestview Dr
Manchester, KY 40962-7012

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
18D2120458Family Practice of Kentucky LLC21 Crestview Drive, Manchester, KY 40962Certificate of waiverOct 17, 2026

National Provider Directory

National Provider Directory

Locations

204 Town Branch Rd
#2
Manchester, KY 40962

470 Manchester Square Shpg Ctr
Manchester, KY 40962
Phone (606) 594-1769

Ownership & related parties

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Dana P Edwards Individual Corporate DirectorDirector Aug 1, 2016
Eva a Edwards Individual 5% Or Greater Direct Ownership Interest Aug 1, 2016 100%
Sheri Sizemore Individual W-2 Managing EmployeeBilling Manager Aug 1, 2016

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 12

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.

NPI Registry JSON

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

{
    "created_epoch": "1439856000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1664755200000",
    "number": "1972979540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "204 TOWN BRANCH RD",
            "city": "MANCHESTER",
            "state": "KY",
            "postal_code": "409621322",
            "telephone_number": "606-596-7196",
            "fax_number": "606-598-1903"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21 CRESTVIEW DR",
            "city": "MANCHESTER",
            "state": "KY",
            "postal_code": "409627012",
            "telephone_number": "606-594-1769",
            "fax_number": "606-596-0473"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY PRACTICE OF KENTUCKY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-18",
        "last_updated": "2022-10-03",
        "certification_date": "2022-10-03",
        "status": "A",
        "authorized_official_last_name": "EDWARDS",
        "authorized_official_first_name": "EVA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "606-594-1769",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "ARNP,FNP-BC,RFNA,CNO"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "KY",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "KY",
            "license": "900342",
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": "KY",
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "KY",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Manchester, KY

Sources for this page

Verify at the official NPI Registry.