Organization
MAIN STREET FAMILY MEDICINE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CYNTHIA DIANNE GLENN-BIRKHEAD ARNP (OWNER)
(270) 233-1884
Entity
Organization
Contact information
Practice address
10015 MAIN ST, WHITESVILLE, KY 42378-9557
(270) 233-1884
(270) 233-9520
Mailing address
10015 MAIN ST, WHITESVILLE, KY 42378-9557
(270) 233-1884
(270) 233-9520
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
—
—
363LF0000X
Family Nurse Practitioner
Primary
2848P
KY
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BLUE CROSS BLUE SHIE
000000480521
KY
01
—
PASSPORT
50010742
KY
Enumeration date
07/02/2006
Last updated
03/21/2022
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