Healthcare Provider Details

I. General information

NPI: 1043130057
Provider Name (Legal Business Name): AYDEN COLE HARRISON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 YMCA WAY
GLASGOW KY
42141-1195
US

IV. Provider business mailing address

217 SIMMENTAL LN
GLASGOW KY
42141-3512
US

V. Phone/Fax

Practice location:
  • Phone: 270-646-8629
  • Fax:
Mailing address:
  • Phone: 270-646-8643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: