Provider Demographics
NPI:1417141326
Name:BRIESE, RACHEL COOPER (PNP)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:COOPER
Last Name:BRIESE
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40422-2091
Mailing Address - Country:US
Mailing Address - Phone:859-236-1080
Mailing Address - Fax:859-236-1862
Practice Address - Street 1:303 S 4TH ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422-2091
Practice Address - Country:US
Practice Address - Phone:859-236-1080
Practice Address - Fax:859-236-1862
Is Sole Proprietor?:No
Enumeration Date:2007-09-04
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3003722363LP0200X
AL1-110909363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3003722OtherAPRN LICENSE
KY7100446430Medicaid