Provider Demographics
NPI:1174821854
Name:NALLY FAMILY PRACTICE PLLC
Entity Type:Organization
Organization Name:NALLY FAMILY PRACTICE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KARI
Authorized Official - Middle Name:N
Authorized Official - Last Name:NALLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-961-5970
Mailing Address - Street 1:11302 PRESTON HWY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40229-2862
Mailing Address - Country:US
Mailing Address - Phone:502-961-5970
Mailing Address - Fax:502-961-5980
Practice Address - Street 1:11302 PRESTON HWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40229-2862
Practice Address - Country:US
Practice Address - Phone:502-961-5970
Practice Address - Fax:502-961-5980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-04
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100160290Medicaid
KYK004941OtherMEDICARE PTAN