Provider Demographics
NPI:1083603484
Name:ANSINELLI, DEBRA J (ARNP)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:J
Last Name:ANSINELLI
Suffix:
Gender:F
Credentials:ARNP
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 2380
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-2380
Mailing Address - Country:US
Mailing Address - Phone:606-324-4745
Mailing Address - Fax:606-326-0165
Practice Address - Street 1:2483 HIGHWAY 644
Practice Address - Street 2:SUITE 103
Practice Address - City:LOUISA
Practice Address - State:KY
Practice Address - Zip Code:41230-9242
Practice Address - Country:US
Practice Address - Phone:606-638-9954
Practice Address - Fax:606-638-3595
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4245P363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2231196Medicaid
KY78011475Medicaid
WV9600053000Medicaid
S60301Medicare UPIN
KY00788010Medicare PIN
WVNP01263Medicare PIN
KY78011475Medicaid
OH2231196Medicaid