Organization
BRACKENRICH FAMILY PRACTICE, PLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KATHRYN FERGUSON (ADMINISTRATIVE ASSISTANT)
(540) 726-2375
Entity
Organization
Contact information
Practice address
363 WOODLAND STREET, RICH CREEK, VA 24147
(540) 726-2375
(540) 726-3573
Mailing address
363 WOODLAND STREET, PO BOX B, RICH CREEK, VA 24147
(540) 726-2375
(540) 726-3573
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0007995002
—
WV
01
—
49D0231961
CLIA NUMBER
VA
Enumeration date
10/16/2006
Last updated
02/20/2024
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