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General NPI Number Information
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NPI Number | 1477364180
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Entity Type | Individual
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Provider Name | NONTASCHA GWEN ROSE MSN, APRN FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 01/14/2025
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Last Update Date | 01/22/2025
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Provider Practice Location Address
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Address Line | 40 MAIN STREET SUITE B
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City | CAMPTON
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State | KY
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Zip | 41301
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Country | US
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Telephone | 606-668-9076
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Fax |
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Provider Business Mailing Address
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Address Line | 419 ROSE BEND RD
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City | CAMPTON
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State | KY
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Zip | 41301-9435
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Country | US
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Telephone | 606-495-5415
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 1141107
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 4034165
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License Number State | KY
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