Individual
INGRID MEDLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
151 DREXLER CIR, STE 1, ELIZABETHTOWN, KY 42701-7843
(270) 506-2730
(270) 900-0704
Mailing address
107 CRANES ROOST CT, ELIZABETHTOWN, KY 42701-3650
(270) 765-2605
(270) 766-1222
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
2641S
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000174962
ANTHEM
KY
01
—
11386453
CAQH
—
05
—
30605018
—
KY
01
—
341184
TRICARE
KY
Enumeration date
05/25/2006
Last updated
01/15/2016
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