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General NPI Number Information
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NPI Number | 1982497293
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Entity Type | Individual
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Provider Name | OLIVIA ROSE SHORT
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Gender | Female
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Dates
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Enumeration Date | 05/28/2025
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Last Update Date | 05/28/2025
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Provider Practice Location Address
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Address Line | 503 DARBY CREEK RD
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City | LEXINGTON
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State | KY
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Zip | 40509-1603
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Country | US
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Telephone | 859-264-8796
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Fax |
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Provider Business Mailing Address
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Address Line | 466 HENRY CLAY BLVD
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City | LEXINGTON
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State | KY
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Zip | 40502-1001
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Country | US
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Telephone | 606-923-5486
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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