Provider Demographics
NPI:1093287815
Name:ROMINES, ALLIE RUSH (PA-C)
Entity Type:Individual
Prefix:
First Name:ALLIE
Middle Name:RUSH
Last Name:ROMINES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-272-5754
Mailing Address - Fax:502-272-5339
Practice Address - Street 1:3 AUDUBON PLAZA DR STE 230
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40217-1319
Practice Address - Country:US
Practice Address - Phone:505-637-3311
Practice Address - Fax:502-637-3168
Is Sole Proprietor?:No
Enumeration Date:2018-12-18
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300037892Medicaid
KY7100662872Medicaid