Provider Demographics
NPI:1043540511
Name:GREEN, ASHLEY ARNETT (PA-C)
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:ARNETT
Last Name:GREEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 SKYVIEW DR
Mailing Address - Street 2:
Mailing Address - City:MT STERLING
Mailing Address - State:KY
Mailing Address - Zip Code:40353-1496
Mailing Address - Country:US
Mailing Address - Phone:859-499-0717
Mailing Address - Fax:859-499-2926
Practice Address - Street 1:148 SKYVIEW DR
Practice Address - Street 2:
Practice Address - City:MOUNT STERLING
Practice Address - State:KY
Practice Address - Zip Code:40353-1496
Practice Address - Country:US
Practice Address - Phone:859-499-0717
Practice Address - Fax:859-499-0926
Is Sole Proprietor?:No
Enumeration Date:2010-01-06
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA1448363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000644197OtherANTHEM
12052669OtherCAQH
KY7100101110Medicaid
12052669OtherCAQH
KY7100101110Medicaid