Healthcare Provider Details

I. General information

NPI: 1487146866
Provider Name (Legal Business Name): ASHLEY ELIZABETH MORAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2018
Last Update Date: 02/16/2022
Certification Date: 02/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 BRECKENRIDGE ST
OWENSBORO KY
42303-1090
US

IV. Provider business mailing address

1200 BRECKENRIDGE ST
OWENSBORO KY
42303-1089
US

V. Phone/Fax

Practice location:
  • Phone: 270-683-8672
  • Fax: 270-685-8223
Mailing address:
  • Phone: 270-684-0028
  • Fax: 270-685-8233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3012453
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: