Provider Demographics
NPI:1689466872
Name:EASLEY, SUSAN (APRN)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:EASLEY
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 1:516 MURRAY AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVERPORT
Mailing Address - State:KY
Mailing Address - Zip Code:40111-1238
Mailing Address - Country:US
Mailing Address - Phone:270-863-1034
Mailing Address - Fax:
Practice Address - Street 1:516 MURRAY AVE
Practice Address - Street 2:
Practice Address - City:CLOVERPORT
Practice Address - State:KY
Practice Address - Zip Code:40111-1238
Practice Address - Country:US
Practice Address - Phone:270-863-1034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-21
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1120444363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily