Provider Demographics
NPI:1528640356
Name:SOUTHERN FAMILY HEALTH & PSYCHIATRY PLLC
Entity type:Organization
Organization Name:SOUTHERN FAMILY HEALTH & PSYCHIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, OWNER, PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:DANIELLE
Authorized Official - Last Name:GOINS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, PMHNP-BC,FNP-C
Authorized Official - Phone:606-268-2504
Mailing Address - Street 1:PO BOX 1839
Mailing Address - Street 2:
Mailing Address - City:BARBOURVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40906-5839
Mailing Address - Country:US
Mailing Address - Phone:606-268-2504
Mailing Address - Fax:606-212-0107
Practice Address - Street 1:1622 CUMBERLAND AVE STE 6
Practice Address - Street 2:
Practice Address - City:MIDDLESBORO
Practice Address - State:KY
Practice Address - Zip Code:40965-1379
Practice Address - Country:US
Practice Address - Phone:606-268-2504
Practice Address - Fax:606-212-0107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-21
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100357680Medicaid