MEDICARE: BLUEGRASS WOUND SOLUTIONS, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LG0600X	Gerontology Nurse Practitioner

General Provider Information

NPI Number	:	1871171496
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLUEGRASS WOUND SOLUTIONS, PLLC

Provider Business Mailing Address
First Line	:	2154 CARTER AVE STE A
Second Line	:
City	:	ASHLAND
State	:	KY
Zip	:	41101-7739
Country	:	US
Telephone Number	:	606-325-6493
Fax Number	:	785-619-6083

Provider Business Practice Location Address
First Line	:	2154 CARTER AVE STE A
Second Line	:
City	:	ASHLAND
State	:	KY
Zip	:	41101-7739
Country	:	US
Telephone Number	:	606-325-6493
Fax Number	:	785-619-6083

Authorized Official
Title or Position	:	OWNER/AUTHORIZED OFFICIAL
Name	:	MS. REBECCA PRIODE
Credential	:	APRN
Telephone Number	:	606-939-4773

Provider Enumeration Date	:	04/02/2021
Last Update Date	:	06/15/2026

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