Provider Demographics
NPI:1306170436
Name:CORDLE, RACHEL ANN (APRN)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:ANN
Last Name:CORDLE
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:PO BOX 1595
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-1595
Mailing Address - Country:US
Mailing Address - Phone:606-408-6200
Mailing Address - Fax:606-408-6612
Practice Address - Street 1:2245 WINCHESTER AVE
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7848
Practice Address - Country:US
Practice Address - Phone:606-408-2600
Practice Address - Fax:606-408-2605
Is Sole Proprietor?:No
Enumeration Date:2009-09-22
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3006182363LF0000X
OH12886-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100113180Medicaid
KYP00846139OtherRR MEDICARE
OH3046331Medicaid
OHP01117862OtherRR MEDICARE
OH3046331Medicaid
OHH126741Medicare PIN
KY0586704Medicare PIN