Provider Demographics
NPI:1093717670
Name:HEDGES, ELLEN E (ARNP, BC, MSN)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:E
Last Name:HEDGES
Suffix:
Gender:F
Credentials:ARNP, BC, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 W MAIN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:PRINCETON
Mailing Address - State:KY
Mailing Address - Zip Code:42445-1219
Mailing Address - Country:US
Mailing Address - Phone:270-365-0310
Mailing Address - Fax:270-365-0480
Practice Address - Street 1:1011 W MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:PRINCETON
Practice Address - State:KY
Practice Address - Zip Code:42445-1219
Practice Address - Country:US
Practice Address - Phone:270-365-0310
Practice Address - Fax:270-365-0480
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2838P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78028388Medicaid
KY000000505346OtherBLUE CROSS
KY000000505346OtherBLUE CROSS
KY78028388Medicaid
KY00193001Medicare PIN
KY0727902Medicare PIN