Provider Demographics
NPI:1720275332
Name:CASEY, RHONDA D (CNS)
Entity type:Individual
Prefix:
First Name:RHONDA
Middle Name:D
Last Name:CASEY
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:RHONDA
Other - Middle Name:AR
Other - Last Name:DERRICKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNS
Mailing Address - Street 1:1930 BISHOP LN
Mailing Address - Street 2:SUITE 1017
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40218-1921
Mailing Address - Country:US
Mailing Address - Phone:502-272-5754
Mailing Address - Fax:502-272-5339
Practice Address - Street 1:3991 DUTCHMANS LN
Practice Address - Street 2:SUITE 405
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4700
Practice Address - Country:US
Practice Address - Phone:502-899-3366
Practice Address - Fax:502-899-3455
Is Sole Proprietor?:No
Enumeration Date:2007-09-27
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3005372364S00000X, 364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP01100047OtherRR MEDICARE
IN200888200Medicaid
KY7100023800Medicaid
50017921OtherPASSPORT
IN630960XMedicare PIN
IN200888200Medicaid
KY7100023800Medicaid