Provider Demographics
NPI:1609143346
Name:PRICE, MICAH ASHLEY (APRN)
Entity Type:Individual
Prefix:
First Name:MICAH
Middle Name:ASHLEY
Last Name:PRICE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MICAH
Other - Middle Name:ASHLEY
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PNP-PC, MSN, RN
Mailing Address - Street 1:PO BOX 23229
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42304-3229
Mailing Address - Country:US
Mailing Address - Phone:270-688-1330
Mailing Address - Fax:270-688-1338
Practice Address - Street 1:1000 BRECKENRIDGE ST STE 300
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-0877
Practice Address - Country:US
Practice Address - Phone:270-688-4480
Practice Address - Fax:270-688-4489
Is Sole Proprietor?:No
Enumeration Date:2011-11-23
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX810537363LP0200X
KY3009096363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100325910Medicaid
IN201282870Medicaid
KYK176640Medicare PIN