Healthcare Provider Details

I. General information

NPI: 1962041715
Provider Name (Legal Business Name): REBECCA PRIODE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2019
Last Update Date: 01/11/2024
Certification Date: 12/21/2023
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 Number3013259
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: