Provider Demographics
NPI:1629794631
Name:PIONEER FAMILY MEDICINE AND URGENT CARE
Entity Type:Organization
Organization Name:PIONEER FAMILY MEDICINE AND URGENT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:270-676-6063
Mailing Address - Street 1:190 N HOPKINSVILLE ST
Mailing Address - Street 2:
Mailing Address - City:NORTONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42442-9799
Mailing Address - Country:US
Mailing Address - Phone:270-676-6063
Mailing Address - Fax:270-676-6064
Practice Address - Street 1:190 N HOPKINSVILLE ST
Practice Address - Street 2:
Practice Address - City:NORTONVILLE
Practice Address - State:KY
Practice Address - Zip Code:42442-9799
Practice Address - Country:US
Practice Address - Phone:270-676-6063
Practice Address - Fax:270-676-6064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-12
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care