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General NPI Number Information
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NPI Number | 1477168169
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Entity Type | Individual
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Provider Name | ELESHIA STEPHENIE AMMERMAN PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/10/2020
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Last Update Date | 09/12/2023
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Provider Practice Location Address
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Address Line | 60 BRYAN BLVD
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City | CORBIN
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State | KY
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Zip | 40701-2779
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Country | US
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Telephone | 606-528-1172
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Fax |
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Provider Business Mailing Address
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Address Line | 343 HARNESS RD
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City | LONDON
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State | KY
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Zip | 40744-8874
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Country | US
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Telephone | 606-312-6989
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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