Organization
MARSHALL COUNTY FAMILY MEDICAL CENTER NURSE PRACTITIONER GROUP
Active
Parent organization
MARSHALL COUNTY FAMILY MEDICAL
Organization subpart
Yes
Provider details
NPI number
Legal business name
MARSHALL COUNTY FAMILY MEDICAL
Authorized official
MARSHA R TUCKER (OFFICE MANAGER)
(270) 527-2273
Entity
Organization
Contact information
Practice address
145 VINE ST # 569, BENTON, KY 42025-7472
(270) 527-2273
Mailing address
145 VINE ST, PO BOX 569, BENTON, KY 42025-7472
(270) 527-2273
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
4072P
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1619907870
NPI INDIVIDUAL
KY
01
—
1689710899
NPI INDIVIDUAL
KY
01
—
1891878641
NPI INDIVIDUAL
KY
05
—
78900180
—
KY
Enumeration date
12/07/2007
Last updated
12/07/2007
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