Individual
JOY ROOSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
ONE MEDICAL VILLAGE DRIVE, INDEPENDENT ANESTHESIOLOGIST PSC, EDGEWOOD, KY 41017
(859) 341-7246
(859) 341-7867
Mailing address
20 MEDICAL VILLAGE DRIVE, #258, EDGEWOOD, KY 41017
(859) 341-7246
(859) 341-7867
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
1076053
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000288568
ANTHEM BLUE SHIELD
—
05
—
0933128
—
OH
05
—
200417780
—
IN
01
—
611077369
TAX ID
—
05
—
74439092
—
KY
Enumeration date
03/02/2006
Last updated
01/20/2016
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