Provider Demographics
NPI:1417967381
Name:WELENKEN, RHONDA ERNST (ARNP)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:ERNST
Last Name:WELENKEN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13102 SPRINGHILL WAY
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:KY
Mailing Address - Zip Code:40059-9712
Mailing Address - Country:US
Mailing Address - Phone:502-228-4579
Mailing Address - Fax:502-228-4579
Practice Address - Street 1:13102 SPRINGHILL WAY
Practice Address - Street 2:
Practice Address - City:PROSPECT
Practice Address - State:KY
Practice Address - Zip Code:40059-9712
Practice Address - Country:US
Practice Address - Phone:502-228-4579
Practice Address - Fax:502-228-4579
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3332P363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78006517Medicaid
KY0947101Medicare ID - Type UnspecifiedMEDICARE NUMBER
KY78006517Medicaid