Provider Demographics
NPI:1669573135
Name:HEALTHFIRST FAMILY MEDICAL CLINIC, LLC.
Entity type:Organization
Organization Name:HEALTHFIRST FAMILY MEDICAL CLINIC, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:L
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:270-781-1101
Mailing Address - Street 1:1830 DESTINY LN
Mailing Address - Street 2:SUITE 118
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-1087
Mailing Address - Country:US
Mailing Address - Phone:270-781-1101
Mailing Address - Fax:270-781-1120
Practice Address - Street 1:1830 DESTINY LN
Practice Address - Street 2:SUITE118
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-1087
Practice Address - Country:US
Practice Address - Phone:270-781-1101
Practice Address - Fax:270-781-1120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4356P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78013109Medicaid
KY78013109Medicaid