1922548981 NPI number — AMBER D EASLEY APRN

Table of content: AMBER D EASLEY APRN (NPI 1922548981)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922548981 NPI number — AMBER D EASLEY APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EASLEY
Provider First Name:
AMBER
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922548981
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/09/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 21890
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELFAST
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04915-4115
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-907-0356
Provider Business Mailing Address Fax Number:
502-919-9780

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 PROSPEROUS PL STE 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40509-1836
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-275-5229
Provider Business Practice Location Address Fax Number:
859-977-2683
Provider Enumeration Date:
02/24/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  3011109 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7100460270 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000001275274 . This is a "ANTHEM PROVIDER ID NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5176891 . This is a "AETNA PROVIDER PIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: QZZ000000204238 . This is a "AETNA BETTER HEALTH OF KY PROVIDER ID NUMBER" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 6347033 . This is a "UNITED HEALTHCARE PROVIDER ID NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: CS1919200189 . This is a "CARESOURCE PROVIDER ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 300016685 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1644897 . This is a "WELLCARE OF KY PROVIDER ID NUMBER" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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