Healthcare Provider Details

I. General information

NPI: 1174432470
Provider Name (Legal Business Name): MORGAN EMILY GLIDEWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILY GLIDEWELL

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 W STOCKTON ST
EDMONTON KY
42129-9458
US

IV. Provider business mailing address

423 WATERVIEW RD
BURKESVILLE KY
42717-8798
US

V. Phone/Fax

Practice location:
  • Phone: 270-432-4320
  • Fax:
Mailing address:
  • Phone: 270-459-1043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4063198
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: