| Organization Name: | EDMONTON PRIMARY CARE NURSING GROUP |
| NPI Number: | 1629240759 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | REX A TUNGATE (CEO, ADMINISTRATOR) |
| Mailing Address: | 903 West Stockton Street Edmonton |
| State: | KY US |
| Postal Code: | 42129 |
| Phone Number: | 2704325782 |
| Fax Number: | 2704320001 |
| NPI Enumeration Date: | 03/28/2008 |
| NPI Last Update Date: | 03/28/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 1854P |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | KY |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |