Healthcare Provider Details

I. General information

NPI: 1629765714
Provider Name (Legal Business Name): ROSLYN Y COULTER CAREGIVER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2023
Last Update Date: 04/19/2023
Certification Date: 04/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7634 EAGLE LANDING WAY
LOUISVILLE KY
40214-5455
US

IV. Provider business mailing address

7634 EAGLE LANDING WAY
LOUISVILLE KY
40214-5455
US

V. Phone/Fax

Practice location:
  • Phone: 502-260-2513
  • Fax:
Mailing address:
  • Phone: 502-260-2513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: