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MAIN STREET MEDICAL CLINIC
NPI 1952180408
Nurse Practitioner - Family in Grayson, KY

Active since September 25, 2023CLIA 18D2288813 · Waiver
107 E MAIN ST, GRAYSON, KY 41143(606) 474-0244(606) 474-0412 Get Directions Write a Review

NPPES record last updated: September 25, 2023. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Main Street Medical Clinic NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MAIN STREET MEDICAL CLINIC (NPI 1952180408) is a healthcare organization registered as a family in Grayson, Kentucky and active in the NPI registry since September 2023. The organization holds a CLIA Waiver certificate valid through August 30, 2027 and lists Stacy Holley, Owner, as its authorized official.

NPPES Registry Identity

NPI1952180408
Entity TypeOrganization
Primary Taxonomy363LF0000X
Legal Business NameMAIN STREET MEDICAL CLINIC
Location Address107 E MAIN STGrayson, KY 41143-1301
Mailing Address107 E Main StGrayson, KY 41143-1301 · (606) 474-0244 · Fax (606) 474-0412
Phone(606) 474-0244
Fax(606) 474-0412
Organization SubpartNo
Authorized OfficialStacy HolleyOwner · (606) 474-0244
Enumeration DateSeptember 25, 2023
NPPES CertifiedSeptember 25, 2023
✔ NPI 1952180408 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LF0000X
107 E MAIN ST, Grayson, KY 41143
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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Buckeye Health Plan, Ambetter from Home State Health, Ambetter Health and more.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 18D2288813

Main Street Medical Clinic · Grayson, KY
Active · expires Aug 30, 2027
CLIA Number18D2288813
Laboratory TypePhysician Office
Certificate Effective DateAugust 31, 2025
Certificate Expiration DateAugust 30, 2027
Laboratory DirectorMs. Stacy B. Holley
Laboratory Phone(606) 474-0244
Laboratory LocationMain Street Medical Clinic107 E Main Street, Grayson, KY 41143
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

STACY HOLLEY FNP
Nurse Practitioner (Family)
107 E MAIN ST
GRAYSON, KY 41143
Carter County (606) 474-0244
VICTORIA RENEE GILLIAM APRN
Nurse Practitioner (Family)
107 E MAIN ST
GRAYSON, KY 41143
Carter County (606) 316-7066
MCCLOUD EYE CARE CENTER INC
Optometrist
107 E MAIN ST
GRAYSON, KY 41143
Carter County (606) 474-5149
DR. JASON H MCCLOUD O.D.
Optometrist
107 E MAIN ST
GRAYSON, KY 41143
Carter County (606) 474-5149

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Main Street Medical Clinic's NPI number?

The NPI number for Main Street Medical Clinic is 1952180408. It was assigned to this organization in the NPPES registry on September 25, 2023.

Where is Main Street Medical Clinic located?

Main Street Medical Clinic is located at 107 E Main St, Grayson, KY 41143. The listed phone number is (606) 474-0244.

What is Main Street Medical Clinic's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Does Main Street Medical Clinic hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 18D2288813) is associated with this NPI, valid through August 30, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Main Street Medical Clinic accept?

Health plans from Ambetter Health, Ambetter from Buckeye Health Plan, Ambetter from Home State Health and Ambetter of Tennessee list Main Street Medical Clinic as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Main Street Medical Clinic was last updated on September 25, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.