Provider Demographics
NPI:1699176495
Name:HANGING FORK PRIMARY CARE PLLC
Entity type:Organization
Organization Name:HANGING FORK PRIMARY CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:606-346-2055
Mailing Address - Street 1:56 CARL RUSSELL STREET
Mailing Address - Street 2:
Mailing Address - City:HUSTONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40437
Mailing Address - Country:US
Mailing Address - Phone:606-346-2055
Mailing Address - Fax:
Practice Address - Street 1:1075 US HWY 127 N
Practice Address - Street 2:
Practice Address - City:HUSTONVILLE
Practice Address - State:KY
Practice Address - Zip Code:40437
Practice Address - Country:US
Practice Address - Phone:606-346-2055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-11
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty