Provider Demographics
NPI:1679737209
Name:NORRIS, ASHLEY ANN (DO)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:ANN
Last Name:NORRIS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:ANN
Other - Last Name:WALLACE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:201 PARK ST
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-1759
Mailing Address - Country:US
Mailing Address - Phone:270-629-5111
Mailing Address - Fax:270-629-5115
Practice Address - Street 1:1330 N RACE ST
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:KY
Practice Address - Zip Code:42141-3465
Practice Address - Country:US
Practice Address - Phone:270-629-5111
Practice Address - Fax:270-629-5115
Is Sole Proprietor?:No
Enumeration Date:2008-07-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY03429207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100193190Medicaid
KYK032020Medicare PIN