Healthcare Provider Details

I. General information

NPI: 1619676921
Provider Name (Legal Business Name): HEATHER JO FORD APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2023
Last Update Date: 08/30/2023
Certification Date: 08/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

466 BURNLEY RD
SCOTTSVILLE KY
42164-6355
US

IV. Provider business mailing address

466 BURNLEY RD
SCOTTSVILLE KY
42164-6355
US

V. Phone/Fax

Practice location:
  • Phone: 270-618-3700
  • Fax:
Mailing address:
  • Phone: 270-618-3700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number1139099
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4008071
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: