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General NPI Number Information
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NPI Number | 1689466872
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Entity Type | Individual
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Provider Name | SUSAN EASLEY APRN
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Gender | Female
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Dates
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Enumeration Date | 05/21/2025
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Last Update Date | 11/07/2025
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Provider Practice Location Address
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Address Line | 516 MURRAY AVE
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City | CLOVERPORT
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State | KY
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Zip | 40111-1238
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Country | US
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Telephone | 270-863-1034
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Fax |
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Provider Business Mailing Address
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Address Line | 2645 LEITCHFIELD RD STE 104
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City | ELIZABETHTOWN
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State | KY
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Zip | 42701-7349
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Country | US
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Telephone | 270-234-8180
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1120444
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License Number State | KY
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