Provider Demographics
NPI:1952357774
Name:MEDLEY, INGRID (ARNP)
Entity Type:Individual
Prefix:
First Name:INGRID
Middle Name:
Last Name:MEDLEY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 CRANES ROOST CT
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-3650
Mailing Address - Country:US
Mailing Address - Phone:270-765-2605
Mailing Address - Fax:270-766-1222
Practice Address - Street 1:151 DREXLER CIR
Practice Address - Street 2:STE 1
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-7843
Practice Address - Country:US
Practice Address - Phone:270-506-2730
Practice Address - Fax:270-900-0704
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2641S363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
11386453OtherCAQH
KY000000174962OtherANTHEM
KY30605018Medicaid
KY341184OtherTRICARE
0026689Medicare ID - Type Unspecified
KY30605018Medicaid
KY0358842Medicare ID - Type UnspecifiedMEDICARE
KY0358641Medicare ID - Type UnspecifiedMEDICARE
P15767Medicare UPIN
KY0358941Medicare ID - Type UnspecifiedMEDICARE
KY0359239Medicare ID - Type UnspecifiedMEDICARE
KY0359042Medicare ID - Type UnspecifiedMEDICARE
KY0762251Medicare PIN