Provider Demographics
NPI:1558654806
Name:MATNEY, ASHLEY ROE JESSIE (MD)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:ROE JESSIE
Last Name:MATNEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1704 W STOCKTON ST
Mailing Address - Street 2:
Mailing Address - City:EDMONTON
Mailing Address - State:KY
Mailing Address - Zip Code:42129-8137
Mailing Address - Country:US
Mailing Address - Phone:270-432-4800
Mailing Address - Fax:270-432-4804
Practice Address - Street 1:1704 W STOCKTON ST
Practice Address - Street 2:
Practice Address - City:EDMONTON
Practice Address - State:KY
Practice Address - Zip Code:42129-8137
Practice Address - Country:US
Practice Address - Phone:270-432-4800
Practice Address - Fax:270-432-4804
Is Sole Proprietor?:No
Enumeration Date:2011-05-19
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY48197208000000X, 207R00000X, 207R00000X, 208000000X
KYTP481207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100358370Medicaid