Provider Demographics
NPI:1851096069
Name:ASAYESH, FARID JAMES (APRN-CNP)
Entity Type:Individual
Prefix:MR
First Name:FARID
Middle Name:JAMES
Last Name:ASAYESH
Suffix:
Gender:M
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 N LEVI RD
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40744-8342
Mailing Address - Country:US
Mailing Address - Phone:606-401-3212
Mailing Address - Fax:
Practice Address - Street 1:1374 HIGHWAY 192 E STE 400
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-3123
Practice Address - Country:US
Practice Address - Phone:606-770-5454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-05
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4000719363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty