Provider Demographics
NPI:1053660852
Name:PAIGE-EMBS, KATHY ROSEZELL (MS)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:ROSEZELL
Last Name:PAIGE-EMBS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 S MAPLE ST
Mailing Address - Street 2:STE 200
Mailing Address - City:WINCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40391-2085
Mailing Address - Country:US
Mailing Address - Phone:859-737-5901
Mailing Address - Fax:859-737-5903
Practice Address - Street 1:114 S MAPLE ST
Practice Address - Street 2:STE 200
Practice Address - City:WINCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40391-2085
Practice Address - Country:US
Practice Address - Phone:859-737-5901
Practice Address - Fax:859-737-5903
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-07
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0009103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1790731081Medicaid