Healthcare Provider Details

I. General information

NPI: 1164354312
Provider Name (Legal Business Name): GLENDA LAYNE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 BATH AVE
ASHLAND KY
41101-2696
US

IV. Provider business mailing address

PO BOX 791
ASHLAND KY
41105-0791
US

V. Phone/Fax

Practice location:
  • Phone: 606-329-8988
  • Fax:
Mailing address:
  • Phone: 606-329-8588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number2051027
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: