Provider Demographics
NPI:1447655683
Name:HOMETOWN HEALTH PLLC
Entity type:Organization
Organization Name:HOMETOWN HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KATRINIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARKER
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:606-316-0270
Mailing Address - Street 1:308 HORTON ST
Mailing Address - Street 2:STE 2
Mailing Address - City:GRAYSON
Mailing Address - State:KY
Mailing Address - Zip Code:41143-1599
Mailing Address - Country:US
Mailing Address - Phone:606-474-4000
Mailing Address - Fax:606-474-4009
Practice Address - Street 1:308 HORTON ST
Practice Address - Street 2:STE 2
Practice Address - City:GRAYSON
Practice Address - State:KY
Practice Address - Zip Code:41143-1599
Practice Address - Country:US
Practice Address - Phone:606-474-4000
Practice Address - Fax:606-474-4009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-30
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3003809P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100337420Medicaid
KY7100337420Medicaid