Provider Demographics
NPI:1942383641
Name:EASLEY, DAVID PRESTON (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:PRESTON
Last Name:EASLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:DAVID
Other - Middle Name:
Other - Last Name:EASLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1213 OLD CANNONS LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4307
Mailing Address - Country:US
Mailing Address - Phone:502-905-8306
Mailing Address - Fax:502-897-3461
Practice Address - Street 1:1357 BARDSTOWN RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40204-1353
Practice Address - Country:US
Practice Address - Phone:502-897-6443
Practice Address - Fax:502-963-5237
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY228322084P0802X, 2084P0805X, 2084P2900X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
No2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64228323Medicaid