Healthcare Provider Details

I. General information

NPI: 1114782182
Provider Name (Legal Business Name): ASHLEY NICOLE BURDEN CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2024
Last Update Date: 06/21/2024
Certification Date: 06/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 E PARRISH AVE STE 201
OWENSBORO KY
42303-1449
US

IV. Provider business mailing address

PO BOX 23229
OWENSBORO KY
42304-3229
US

V. Phone/Fax

Practice location:
  • Phone: 270-926-3700
  • Fax: 270-926-0368
Mailing address:
  • Phone: 270-691-8070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number3011951
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberCNM04646
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: