Provider Demographics
NPI:1902242613
Name:NANCY FAMILY PRACTICE, PLLC
Entity type:Organization
Organization Name:NANCY FAMILY PRACTICE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO/CO-OWNER/PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:L
Authorized Official - Last Name:WILLIAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:APRN FNP-C
Authorized Official - Phone:606-636-4214
Mailing Address - Street 1:PO BOX 100
Mailing Address - Street 2:7238 WEST HWY 80
Mailing Address - City:NANCY
Mailing Address - State:KY
Mailing Address - Zip Code:42544-0100
Mailing Address - Country:US
Mailing Address - Phone:606-636-4214
Mailing Address - Fax:606-636-4215
Practice Address - Street 1:7238 W HIGHWAY 80
Practice Address - Street 2:
Practice Address - City:NANCY
Practice Address - State:KY
Practice Address - Zip Code:42544-8752
Practice Address - Country:US
Practice Address - Phone:606-636-4214
Practice Address - Fax:606-636-4215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-21
Last Update Date:2019-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY900330261QR1300X, 261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100259250Medicaid