Provider Demographics
NPI:1639353741
Name:PRINCETON FAMILY CARE, PLLC
Entity Type:Organization
Organization Name:PRINCETON FAMILY CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/APRN
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:270-365-2494
Mailing Address - Street 1:PO BOX 190
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:KY
Mailing Address - Zip Code:42445
Mailing Address - Country:US
Mailing Address - Phone:270-365-2494
Mailing Address - Fax:270-365-2496
Practice Address - Street 1:323 C SOUTH JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:KY
Practice Address - Zip Code:42445
Practice Address - Country:US
Practice Address - Phone:270-365-2494
Practice Address - Fax:270-365-2496
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRINCETON FAMILY CARE, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-26
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100027710Medicaid
KY7100027710Medicaid
KY00568Medicare PIN
KYDH0803Medicare PIN