Healthcare Provider Details

I. General information

NPI: 1871171496
Provider Name (Legal Business Name): BLUEGRASS WOUND SOLUTIONS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2021
Last Update Date: 01/11/2024
Certification Date: 01/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 21ST ST
ASHLAND KY
41101-7726
US

IV. Provider business mailing address

330 21ST ST
ASHLAND KY
41101-7726
US

V. Phone/Fax

Practice location:
  • Phone: 606-325-6493
  • Fax: 606-324-9101
Mailing address:
  • Phone: 606-325-6493
  • Fax: 606-324-9101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MS. REBECCA PRIODE
Title or Position: OWNER/AUTHORIZED OFFICIAL
Credential: APRN
Phone: 606-325-6493