Healthcare Provider Details

I. General information

NPI: 1104550649
Provider Name (Legal Business Name): ASHLEY DANIELLE CALLEBS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2022
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 LONDON MOUNTAIN VIEW DR
LONDON KY
40741-6601
US

IV. Provider business mailing address

PO BOX 936
LONDON KY
40743-0936
US

V. Phone/Fax

Practice location:
  • Phone: 606-330-7900
  • Fax: 606-330-7905
Mailing address:
  • Phone: 606-330-7835
  • Fax: 606-330-7905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3017775
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: