Healthcare Provider Details

I. General information

NPI: 1093287815
Provider Name (Legal Business Name): ALLIE RUSH ROMINES PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2018
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 N GRAND AVE STE 101
FORT THOMAS KY
41075-1765
US

IV. Provider business mailing address

PO BOX 2226
LEXINGTON KY
40588-2226
US

V. Phone/Fax

Practice location:
  • Phone: 859-781-4900
  • Fax: 859-572-3039
Mailing address:
  • Phone: 859-781-4900
  • Fax: 502-272-5339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: