Provider Demographics
NPI:1780679308
Name:OWENSBORO MEDICAL PRACTICE, PLLC
Entity Type:Organization
Organization Name:OWENSBORO MEDICAL PRACTICE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ARNP-C
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:BRYANT
Authorized Official - Last Name:ENGLISH
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP-C
Authorized Official - Phone:270-683-8672
Mailing Address - Street 1:1200 BRECKENRIDGE ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-1089
Mailing Address - Country:US
Mailing Address - Phone:270-683-8672
Mailing Address - Fax:270-685-8233
Practice Address - Street 1:1200 BRECKENRIDGE ST
Practice Address - Street 2:SUITE 101
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-1089
Practice Address - Country:US
Practice Address - Phone:270-683-8672
Practice Address - Fax:270-685-8233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4645P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty