Provider Demographics
NPI:1720876519
Name:JERVIS, RONDA LEE
Entity type:Individual
Prefix:
First Name:RONDA
Middle Name:LEE
Last Name:JERVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 TUG FORK DR APT 3F
Mailing Address - Street 2:
Mailing Address - City:BELFRY
Mailing Address - State:KY
Mailing Address - Zip Code:41514-9170
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:38 TUG FORK DR APT 3F
Practice Address - Street 2:
Practice Address - City:BELFRY
Practice Address - State:KY
Practice Address - Zip Code:41514-9170
Practice Address - Country:US
Practice Address - Phone:304-733-1094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-30
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant