Basic Information
| Provider Information | |||||||||
| NPI: | 1629306451 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROTHROCK | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | EMBRY | ||||||||
| NamePrefix: | |||||||||
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| Credential: | CRNA | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | EMBRY | ||||||||
| OtherFirstName: | AMANDA | ||||||||
| OtherMiddleName: | NICOLE | ||||||||
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| OtherCredential: | CRNA | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 320 WHITTINGTON PKWY | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402224928 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5026908782 | ||||||||
| FaxNumber: | 5023652255 | ||||||||
| Practice Location | |||||||||
| Address1: | 320 WHITTINGTON PKWY | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402224928 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5026908782 | ||||||||
| FaxNumber: | 5023652255 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/07/2009 | ||||||||
| LastUpdateDate: | 01/22/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 3006324 | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 163W00000X | 1103759 | KY | N | Nursing Service Providers | Registered Nurse |
No ID Information.