Healthcare Provider Details

I. General information

NPI: 1104598242
Provider Name (Legal Business Name): ROSEANN A. KIEP APN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2021
Last Update Date: 09/28/2021
Certification Date: 09/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

285 BIELBY RD
LAWRENCEBURG IN
47025-1055
US

IV. Provider business mailing address

540 SOUTHWOOD DR
HAMILTON OH
45013-3710
US

V. Phone/Fax

Practice location:
  • Phone: 812-537-1302
  • Fax:
Mailing address:
  • Phone: 812-621-0351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number28130290A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number71011558A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: