Provider Demographics
NPI:1316316235
Name:ROAN, NICOLE ALEXIS (APRN)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:ALEXIS
Last Name:ROAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:NICOLE
Other - Middle Name:ALEXIS
Other - Last Name:ROMINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:800 ZORN AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206
Mailing Address - Country:US
Mailing Address - Phone:502-287-4000
Mailing Address - Fax:502-287-5095
Practice Address - Street 1:800 ZORN AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40206
Practice Address - Country:US
Practice Address - Phone:502-287-4000
Practice Address - Fax:502-287-5095
Is Sole Proprietor?:No
Enumeration Date:2015-09-21
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3009425363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health