Healthcare Provider Details

I. General information

NPI: 1255124160
Provider Name (Legal Business Name): ELENA BOTSFORD PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2025
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 FLEMINGSBURG RD 202A CHER
MOREHEAD KY
40351-1015
US

IV. Provider business mailing address

245 FLEMINGSBURG RD
MOREHEAD KY
40351-1015
US

V. Phone/Fax

Practice location:
  • Phone: 606-780-5500
  • Fax: 606-780-2373
Mailing address:
  • Phone: 606-780-5500
  • Fax: 606-780-2373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA3720
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: