Healthcare Provider Details

I. General information

NPI: 1770798860
Provider Name (Legal Business Name): FAY ELLYN RAWSON NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 N EAGLE CREEK DR
LEXINGTON KY
40509-1805
US

IV. Provider business mailing address

277 VALLEY BROOK DRIVE
LEXINGTON KY
40511-8783
US

V. Phone/Fax

Practice location:
  • Phone: 859-967-5778
  • Fax:
Mailing address:
  • Phone: 859-619-1431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number2592P
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: