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General NPI Number Information
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NPI Number | 1578357794
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Entity Type | Organization
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Legal Business Name | NKY WELLNESS CLINIC LLC
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Dates
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Enumeration Date | 04/04/2025
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Last Update Date | 04/04/2025
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Provider Practice Location Address
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Address Line | 7310 TURFWAY RD STE 550
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City | FLORENCE
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State | KY
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Zip | 41042-4872
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Country | US
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Telephone | 859-203-5963
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Fax |
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Provider Business Mailing Address
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Address Line | 10441 BROOKHURST LN N
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City | UNION
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State | KY
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Zip | 41091-3401
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Country | US
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Telephone | 859-907-5816
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ASHLEIGH EVERSOLE
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Credential | APRN
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Telephone | 859-907-5816
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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