Healthcare Provider Details

I. General information

NPI: 1013553627
Provider Name (Legal Business Name): LAURA ASHLEY SHORT APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LAURA ASHLEY ALLISON APRN

II. Dates (important events)

Enumeration Date: 11/19/2019
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

336 HIGHLAND LAKES DR
RICHMOND KY
40475-3832
US

IV. Provider business mailing address

336 HIGHLAND LAKES DR
RICHMOND KY
40475-3832
US

V. Phone/Fax

Practice location:
  • Phone: 859-200-3404
  • Fax: 859-545-4929
Mailing address:
  • Phone: 859-200-3404
  • Fax: 859-545-4929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number3014073
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number101.0138543TELE
License Number StateVT
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3014073
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1135867
License Number StateKY
# 5
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number16793
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: