Healthcare Provider Details

I. General information

NPI: 1912603937
Provider Name (Legal Business Name): DANIELLE JUSTICE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2023
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2930 CARTER AVE
ASHLAND KY
41101-1943
US

IV. Provider business mailing address

2504 LEXINGTON AVE
ASHLAND KY
41101-2946
US

V. Phone/Fax

Practice location:
  • Phone: 606-324-1483
  • Fax:
Mailing address:
  • Phone: 740-464-7092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4051623
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number115545
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: