Provider Demographics
NPI:1043289663
Name:LUDLOW, MICHAEL D (APRN)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:D
Last Name:LUDLOW
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2917
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41502-2917
Mailing Address - Country:US
Mailing Address - Phone:606-218-3500
Mailing Address - Fax:
Practice Address - Street 1:911 BYPASS RD
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-1689
Practice Address - Country:US
Practice Address - Phone:606-218-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3004829363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78017001Medicaid
KY000000522691OtherBCBS- CUMBERLAND CLINIC
KY78017001Medicaid
0768713Medicare ID - Type Unspecified
KY00190002Medicare PIN
P69753Medicare UPIN
KY000000522691OtherBCBS- CUMBERLAND CLINIC
0768613Medicare ID - Type Unspecified
0930811Medicare ID - Type Unspecified
0938509Medicare ID - Type Unspecified