Organization
FAMILY PRACTICE CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SCOTT R GRAHAM MD (OWNER)
(270) 545-3386
Entity
Organization
Contact information
Practice address
700 CASSIDY AVE, FREDONIA, KY 42411
(270) 545-3386
(270) 545-3712
Mailing address
PO BOX 195, 700 CASSIDY AVE, FREDONIA, KY 42411
(270) 545-3386
(270) 545-3712
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
3001776
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
78903812
—
KY
Enumeration date
02/09/2007
Last updated
06/26/2014
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