Healthcare Provider Details

I. General information

NPI: 1285029926
Provider Name (Legal Business Name): RHONDA JEAN PETTY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2015
Last Update Date: 07/13/2020
Certification Date: 07/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 ROSE ST
LEXINGTON KY
40536-0001
US

IV. Provider business mailing address

800 ROSE ST
LEXINGTON KY
40536-0001
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-5000
  • Fax:
Mailing address:
  • Phone: 859-323-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number3009326
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number3009326
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: