Provider Demographics
NPI:1023707502
Name:COLEY, MARESSA (NP)
Entity type:Individual
Prefix:MS
First Name:MARESSA
Middle Name:
Last Name:COLEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6302 HIGHWAY 44 E
Mailing Address - Street 2:
Mailing Address - City:SHEPHERDSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40165-6816
Mailing Address - Country:US
Mailing Address - Phone:502-572-9019
Mailing Address - Fax:
Practice Address - Street 1:6302 HIGHWAY 44 E
Practice Address - Street 2:
Practice Address - City:SHEPHERDSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40165-6816
Practice Address - Country:US
Practice Address - Phone:502-572-9019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-02
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4002210363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily