Organization
FAMILY PRACTICE OF KENTUCKY LLC
Active
Organization
FAMILY PRACTICE OF KENTUCKY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. EVA A EDWARDS ARNP,FNP-BC,RFNA,CNO (OWNER)
(606) 594-1769
Entity
Organization
Contact information
Practice address
21 CRESTVIEW DR, MANCHESTER, KY 40962-7012
(606) 594-1769
(606) 596-0473
Mailing address
204 TOWN BRANCH RD, MANCHESTER, KY 40962-1322
(606) 596-7196
(606) 598-1903
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
KY
207Q00000X
Family Medicine Physician
900342
KY
261QM1300X
Multi-Specialty Clinic/Center
—
—
261QR1300X
Rural Health Clinic/Center
Primary
—
—
363L00000X
Nurse Practitioner
—
KY
363LF0000X
Family Nurse Practitioner
—
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
188978
MEDICARE PART A
KY
01
—
193200000X
TAXONOMY MULTI SPECIALTY
KY
05
—
7100537420
—
KY
01
—
900342
COMMONWEALTH OF KY PROVISIONAL LICENSE
KY
Enumeration date
08/18/2015
Last updated
10/03/2022
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