Provider Demographics
NPI:1871171496
Name:BLUEGRASS WOUND SOLUTIONS, PLLC
Entity type:Organization
Organization Name:BLUEGRASS WOUND SOLUTIONS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/AUTHORIZED OFFICIAL
Authorized Official - Prefix:MS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:PRIODE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:606-325-6493
Mailing Address - Street 1:330 21ST ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-7726
Mailing Address - Country:US
Mailing Address - Phone:606-325-6493
Mailing Address - Fax:606-324-9101
Practice Address - Street 1:330 21ST ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7726
Practice Address - Country:US
Practice Address - Phone:606-325-6493
Practice Address - Fax:606-324-9101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-02
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty