Provider Demographics
NPI:1265844781
Name:CONVENIENT CARE FAMILY MEDICAL
Entity Type:Organization
Organization Name:CONVENIENT CARE FAMILY MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ NP
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:CHERYLL
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:615-293-4172
Mailing Address - Street 1:11302 PRESTON HWY
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40229-2862
Mailing Address - Country:US
Mailing Address - Phone:615-293-4172
Mailing Address - Fax:
Practice Address - Street 1:11302 PRESTON HWY
Practice Address - Street 2:SUITE 2
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40229-2862
Practice Address - Country:US
Practice Address - Phone:615-293-4172
Practice Address - Fax:931-527-3414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care