Healthcare Provider Details

I. General information

NPI: 1538318290
Provider Name (Legal Business Name): AUDREY MARIE ECKERLE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2008
Last Update Date: 05/02/2024
Certification Date: 05/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 S 2ND ST
DANVILLE KY
40422-1804
US

IV. Provider business mailing address

150 WAR ADMIRAL STE 4
DANVILLE KY
40422-8690
US

V. Phone/Fax

Practice location:
  • Phone: 859-236-6300
  • Fax: 859-236-6308
Mailing address:
  • Phone: 859-236-6300
  • Fax: 859-236-6308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number5696P
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: