Provider Demographics
NPI:1922548981
Name:EASLEY, AMBER D (APRN)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:D
Last Name:EASLEY
Suffix:
Gender:F
Credentials:APRN
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 21890
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4115
Mailing Address - Country:US
Mailing Address - Phone:502-907-0356
Mailing Address - Fax:502-919-9780
Practice Address - Street 1:101 PROSPEROUS PL STE 300
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1836
Practice Address - Country:US
Practice Address - Phone:859-275-5229
Practice Address - Fax:859-977-2683
Is Sole Proprietor?:No
Enumeration Date:2017-02-24
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3011109363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100460270Medicaid
000001275274OtherANTHEM PROVIDER ID NUMBER
5176891OtherAETNA PROVIDER PIN
KYQZZ000000204238OtherAETNA BETTER HEALTH OF KY PROVIDER ID NUMBER
6347033OtherUNITED HEALTHCARE PROVIDER ID NUMBER
CS1919200189OtherCARESOURCE PROVIDER ID
IN300016685Medicaid
KY1644897OtherWELLCARE OF KY PROVIDER ID NUMBER