Individual
KELLY PREASMYER ROUNSAVALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
4000 KRESGE WAY, LOUISVILLE, KY 40207-4605
(502) 473-2132
(502) 459-0923
Mailing address
PO BOX 34748, LOUISVILLE, KY 40232-4748
(502) 473-2132
(502) 459-0923
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
1114347
KY
367500000X
Certified Registered Nurse Anesthetist
Primary
3007128
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7100181800
KENTUCKY MEDICAID
KY
01
—
K029270
MEDICARE PTAN
KY
Enumeration date
08/23/2011
Last updated
11/01/2012
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