Provider Demographics
NPI:1497947485
Name:EASLEY, MARY BIDDLE (ARNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:BIDDLE
Last Name:EASLEY
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 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:9880 ANGIES WAY
Practice Address - Street 2:SUITE 110
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-2851
Practice Address - Country:US
Practice Address - Phone:502-446-6160
Practice Address - Fax:502-446-6161
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY444425363LF0000X
KY5341P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200921910Medicaid
KY50023119OtherPASSPORT- CARDIOTHORACIC SURGERY OF LOUISVILLE
KY00533114OtherMEDICARE- CARDIOTHORACIC SURGERY OF LOUISVILLE
KY200921910OtherMANAGED HEALTH SERVICES- CARDIOTHORACIC SURGERY OF LOUISVILLE
KY7100067770OtherMEDICAID KY- CARDIOTHORACIC SURGERY OF LOUISVILLE
KY000000605378OtherANTHEM- CARDIOTHORACIC SURGERY
KY102761OtherSIHO- CARDIOTHORACIC SURGERY OF LOUISVILLE
KY200921910OtherANTHEM INDIANA MEDICAID
KY3704052000OtherPASSPORT ADVANTAGE- CARDIOTHORACIC SURGERY OF LOUISVILLE
KY000023035ZOtherHUMANA- CARDIOTHORACIC SURGERY OF LOUISVILLE
KY200921910OtherMD WISE- CARDIOTHORACIC SURGERY OF LOUISVILLE
KY200921910OtherMANAGED HEALTH SERVICES- CARDIOTHORACIC SURGERY OF LOUISVILLE
KY3704052000OtherPASSPORT ADVANTAGE- CARDIOTHORACIC SURGERY OF LOUISVILLE
KY0031015Medicare PIN
KY0690826Medicare PIN
INM400050184Medicare PIN
KY00311015Medicare PIN
KY000000605378OtherANTHEM- CARDIOTHORACIC SURGERY
KY102761OtherSIHO- CARDIOTHORACIC SURGERY OF LOUISVILLE
KY00533114OtherMEDICARE- CARDIOTHORACIC SURGERY OF LOUISVILLE
IN200921910Medicaid
KY00314015Medicare PIN
KY00312015Medicare PIN
KY00309015Medicare PIN