| NPI | 1346323383 |
|---|---|
| Former Legal Business Name | FORT LOGAN CLINIC |
| Entity Type | Organization |
| Authorized Contact | KAREN CLICK Office Manager 606-365-9181 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 17220) |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2018-06-21 |