Provider Demographics
NPI:1720848187
Name:HEDGER, SUELLEN (APRN)
Entity Type:Individual
Prefix:MS
First Name:SUELLEN
Middle Name:
Last Name:HEDGER
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 1:440 FORT HENRY DR
Mailing Address - Street 2:
Mailing Address - City:FT WRIGHT
Mailing Address - State:KY
Mailing Address - Zip Code:41011-1828
Mailing Address - Country:US
Mailing Address - Phone:859-512-9505
Mailing Address - Fax:
Practice Address - Street 1:440 FORT HENRY DR
Practice Address - Street 2:
Practice Address - City:FT WRIGHT
Practice Address - State:KY
Practice Address - Zip Code:41011-1828
Practice Address - Country:US
Practice Address - Phone:859-512-9505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4017327363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily