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General NPI Number Information
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NPI Number | 1467362756
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Entity Type | Organization
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Legal Business Name | GREY STREET COLLABORATIVE LLC
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Dates
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Enumeration Date | 09/09/2026
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Last Update Date | 09/09/2026
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Provider Practice Location Address
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Address Line | 1931 BEASLEY LN
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City | CAMPBELLSBURG
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State | KY
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Zip | 40011-6700
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Country | US
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Telephone | 502-667-0321
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Fax | 972-928-6614
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Provider Business Mailing Address
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Address Line | 1931 BEASLEY LN
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City | CAMPBELLSBURG
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State | KY
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Zip | 40011-6700
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Country | US
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Telephone | 502-667-0321
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Fax | 972-928-6614
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Authorized Official
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Title or Position | OWNER
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Name | ASHLEY MAUREEN BAKER
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Credential | APRN
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Telephone | 502-667-0321
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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