Healthcare Provider Details

I. General information

NPI: 1710558572
Provider Name (Legal Business Name): ASHLEY SHANNON BSN, RN, CDCES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2021
Last Update Date: 07/02/2021
Certification Date: 07/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 NICHOLASVILLE RD
LEXINGTON KY
40503-1431
US

IV. Provider business mailing address

1740 NICHOLASVILLE RD
LEXINGTON KY
40503-1431
US

V. Phone/Fax

Practice location:
  • Phone: 859-260-5282
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number1106792
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: