Provider Demographics
NPI:1104943943
Name:NOVA FAMILY MEDICINE INC
Entity type:Organization
Organization Name:NOVA FAMILY MEDICINE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-735-1690
Mailing Address - Street 1:800 CARDINAL DR
Mailing Address - Street 2:#202
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-3902
Mailing Address - Country:US
Mailing Address - Phone:270-735-1690
Mailing Address - Fax:270-735-1696
Practice Address - Street 1:800 CARDINAL DR
Practice Address - Street 2:#202
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-3902
Practice Address - Country:US
Practice Address - Phone:270-735-1690
Practice Address - Fax:270-735-1696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5134P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty