Provider Demographics
NPI:1073717286
Name:FAMILY HEALTH CARE CLINIC PSC
Entity type:Organization
Organization Name:FAMILY HEALTH CARE CLINIC PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAY
Authorized Official - Middle Name:
Authorized Official - Last Name:STEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:859-626-9696
Mailing Address - Street 1:PO BOX 35
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40476-0035
Mailing Address - Country:US
Mailing Address - Phone:859-626-9696
Mailing Address - Fax:
Practice Address - Street 1:312 JASON DR
Practice Address - Street 2:SUITE 9
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-2785
Practice Address - Country:US
Practice Address - Phone:859-626-9696
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3002572363LF0000X
KY900186261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY35001890Medicaid
KY35001890Medicaid