MEDICARE: ALYSSA C ESTES APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	1140629	KY
2	363LF0000X	Family Nurse Practitioner	3013457	KY

General Provider Information

NPI Number	:	1346808300
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYSSA C ESTES APRN

Provider Business Mailing Address
First Line	:	1049 HIGHWAY 11 N
Second Line	:
City	:	BEATTYVILLE
State	:	KY
Zip	:	41311-9240
Country	:	US
Telephone Number	:	606-464-8806
Fax Number	:	606-464-9453

Provider Business Practice Location Address
First Line	:	1049 HIGHWAY 11 N
Second Line	:
City	:	BEATTYVILLE
State	:	KY
Zip	:	41311-9240
Country	:	US
Telephone Number	:	606-464-8806
Fax Number	:	606-464-9453

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2019
Last Update Date	:	06/27/2019

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