Healthcare Provider Details

I. General information

NPI: 1528798311
Provider Name (Legal Business Name): ROSE MARIE CAMPBELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2022
Last Update Date: 03/09/2026
Certification Date: 03/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

799 E BRANNON RD
NICHOLASVILLE KY
40356-6038
US

IV. Provider business mailing address

109 WIND HAVEN DR STE 100
NICHOLASVILLE KY
40356-8010
US

V. Phone/Fax

Practice location:
  • Phone: 859-224-2273
  • Fax: 859-224-4675
Mailing address:
  • Phone: 859-224-2273
  • Fax: 859-224-4675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number282547
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-22-220001
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: