Healthcare Provider Details

I. General information

NPI: 1750969093
Provider Name (Legal Business Name): ASHLEY EWERT DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2021
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 WOODLAND DR
ELIZABETHTOWN KY
42701-2749
US

IV. Provider business mailing address

71401 JULIUS DR
BRUCE TOWNSHIP MI
48065-3184
US

V. Phone/Fax

Practice location:
  • Phone: 270-769-5963
  • Fax: 270-769-9051
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number5151014960
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number06047
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: