Healthcare Provider Details

I. General information

NPI: 1376902247
Provider Name (Legal Business Name): MICHELLE SORRELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2016
Last Update Date: 08/22/2022
Certification Date: 08/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 WINCHESTER AVE
ASHLAND KY
41101-7743
US

IV. Provider business mailing address

PO BOX 2379
ASHLAND KY
41105-2379
US

V. Phone/Fax

Practice location:
  • Phone: 606-324-7351
  • Fax:
Mailing address:
  • Phone: 606-324-7351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0030680
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3010086
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: