Healthcare Provider Details

I. General information

NPI: 1720544232
Provider Name (Legal Business Name): COREY SALYER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2019
Last Update Date: 02/24/2025
Certification Date: 02/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL VILLAGE DRIVE
EDGEWOOD KY
41017-3403
US

IV. Provider business mailing address

181 FAIRFIELD AVE
NEWARK OH
43055-4627
US

V. Phone/Fax

Practice location:
  • Phone: 859-301-5652
  • Fax:
Mailing address:
  • Phone: 740-814-3955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4035700
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRNCNP024295
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.024295
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: