Healthcare Provider Details

I. General information

NPI: 1467211466
Provider Name (Legal Business Name): ASHLEY SANSOM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2024
Last Update Date: 03/13/2024
Certification Date: 03/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 W RUSSELL ST
ELKHORN CITY KY
41522-9023
US

IV. Provider business mailing address

65 COLEMAN RD
ELKHORN CITY KY
41522-7864
US

V. Phone/Fax

Practice location:
  • Phone: 606-754-8445
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number1162976
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: