| Family Practice Of Kentucky Llc | |
|
21 Crestview Dr Manchester KY 40962-7012 | |
| (606) 594-1769 | |
| (606) 596-0473 |
| Full Name | Family Practice Of Kentucky Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 21 Crestview Dr, Manchester, Kentucky |
| Authorized Official Name and Position | Eva A Edwards (OWNER) |
| Authorized Official Contact | 6065941769 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Family Practice Of Kentucky Llc 204 Town Branch Rd Manchester KY 40962-1322 Ph: (606) 596-7196 | Family Practice Of Kentucky Llc 21 Crestview Dr Manchester KY 40962-7012 Ph: (606) 594-1769 |
| NPI Number | 1972979540 |
|---|---|
| Provider Enumeration Date | 08/18/2015 |
| Last Update Date | 10/03/2022 |
| Certification Date | 10/03/2022 |
| Medicare PECOS PAC ID | 2961790167 |
|---|---|
| Medicare Enrollment ID | O20161004000230 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972979540 | NPI | - | NPPES |
| 193200000X | Other | KY | TAXONOMY MULTI SPECIALTY |
| 188978 | Other | KY | MEDICARE PART A |
| 900342 | Other | KY | COMMONWEALTH OF KY PROVISIONAL LICENSE |
| 7100537420 | Medicaid | KY |
| Provider Name | Dana P Edwards |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1164424131 PECOS PAC ID: 2769434851 Enrollment ID: I20050217000032 |
| Provider Name | Jill Shawn Jones |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1649229352 PECOS PAC ID: 3779520044 Enrollment ID: I20050408000741 |
| Provider Name | Tammy S Saylor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821439746 PECOS PAC ID: 3971746850 Enrollment ID: I20130823001247 |
| Provider Name | Betty Ann Alevras |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346627296 PECOS PAC ID: 2567751670 Enrollment ID: I20160512001649 |
| Provider Name | Eva A Edwards |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396964102 PECOS PAC ID: 3971899766 Enrollment ID: I20161004000389 |
| Provider Name | Kristina M Byrd |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326498338 PECOS PAC ID: 0042598062 Enrollment ID: I20161026001650 |
| Provider Name | Amber Henson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205386786 PECOS PAC ID: 7517241466 Enrollment ID: I20170221002601 |
| Provider Name | Kayla Roach |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205606282 PECOS PAC ID: 0648623462 Enrollment ID: I20240129002339 |
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