Healthcare Provider Details

I. General information

NPI: 1932695137
Provider Name (Legal Business Name): GINA ROESSLER DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2018
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 NEW HARTFORD RD
OWENSBORO KY
42303-1320
US

IV. Provider business mailing address

2801 NEW HARTFORD RD
OWENSBORO KY
42303-1320
US

V. Phone/Fax

Practice location:
  • Phone: 270-683-3720
  • Fax: 270-686-7331
Mailing address:
  • Phone: 270-683-3720
  • Fax: 270-686-7331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number05843
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number5101024151
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number05483
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: