Provider Demographics
NPI:1750557302
Name:FREEMAN FAMILY PRACTICE LLC
Entity type:Organization
Organization Name:FREEMAN FAMILY PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:L
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:606-258-8050
Mailing Address - Street 1:10755 N US HIGHWAY 25E
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:KY
Mailing Address - Zip Code:40734-6529
Mailing Address - Country:US
Mailing Address - Phone:606-258-8050
Mailing Address - Fax:606-258-8050
Practice Address - Street 1:10755 N US HIGHWAY 25E
Practice Address - Street 2:
Practice Address - City:GRAY
Practice Address - State:KY
Practice Address - Zip Code:40734-6529
Practice Address - Country:US
Practice Address - Phone:606-258-8050
Practice Address - Fax:606-258-8994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-05
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2597P363LF0000X
KY900220261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY183964Medicare PIN