Provider Demographics
NPI:1063809523
Name:FH&L FAMILY PRACTICE LLC
Entity type:Organization
Organization Name:FH&L FAMILY PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:JESSIE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:270-432-2444
Mailing Address - Street 1:PO BOX 26
Mailing Address - Street 2:
Mailing Address - City:EDMONTON
Mailing Address - State:KY
Mailing Address - Zip Code:42129-0026
Mailing Address - Country:US
Mailing Address - Phone:270-432-2444
Mailing Address - Fax:270-432-2445
Practice Address - Street 1:109 SARTIN DR
Practice Address - Street 2:
Practice Address - City:EDMONTON
Practice Address - State:KY
Practice Address - Zip Code:42129-8170
Practice Address - Country:US
Practice Address - Phone:270-670-5960
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-22
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty