# BRACKENRICH FAMILY PRACTICE, PLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1235229576
- **Authorized official:** MRS. KATHRYN FERGUSON (ADMINISTRATIVE ASSISTANT)
- **Authorized official phone:** (540) 726-2375

## Contact information

- **Practice address:** 363 WOODLAND STREET, RICH CREEK, VA 24147
- **Practice address phone:** (540) 726-2375
- **Practice address fax:** (540) 726-3573
- **Mailing address:** 363 WOODLAND STREET, PO BOX B, RICH CREEK, VA 24147
- **Mailing address phone:** (540) 726-2375
- **Mailing address fax:** (540) 726-3573

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 10/16/2006
- **Last updated:** 02/20/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0007995002 | — | WV |
| 01 | — | 49D0231961 | CLIA NUMBER | VA |