Individual
ELEANOR LAUREN ROTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
800 ROSE ST, LEXINGTON, KY 40536-7001
(859) 257-1000
Mailing address
800 ROSE ST, LEXINGTON, KY 40536-7001
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
50.006612RX
OH
363A00000X
Physician Assistant
Primary
TC991
KY
363AM0700X
Medical Physician Assistant
50.006612RX
OH
363AM0700X
Medical Physician Assistant
TC991
KY
363AS0400X
Surgical Physician Assistant
TC991
KY
Other
Enumeration date
11/23/2020
Last updated
12/08/2020
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