Healthcare Provider Details

I. General information

NPI: 1891602900
Provider Name (Legal Business Name): RAPHA MENTAL HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 DOUBLE T LN
CORBIN KY
40701-8800
US

IV. Provider business mailing address

314 DOUBLE T LN
CORBIN KY
40701-8800
US

V. Phone/Fax

Practice location:
  • Phone: 606-617-8161
  • Fax:
Mailing address:
  • Phone: 606-617-8161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: ROXANNE ALDERMAN
Title or Position: PMHNP
Credential: PMHNP-BC
Phone: 606-617-8161