Provider Demographics
NPI:1508294174
Name:BOTKINS, RODMAN PRICE JR (APRN)
Entity Type:Individual
Prefix:MR
First Name:RODMAN
Middle Name:PRICE
Last Name:BOTKINS
Suffix:JR
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 S JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1675
Mailing Address - Country:US
Mailing Address - Phone:502-681-1360
Mailing Address - Fax:502-562-3676
Practice Address - Street 1:530 S JACKSON ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1675
Practice Address - Country:US
Practice Address - Phone:502-681-1360
Practice Address - Fax:502-562-3676
Is Sole Proprietor?:No
Enumeration Date:2013-10-17
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3008330363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100281230Medicaid
KYK121931Medicare PIN
KYK121935Medicare PIN
KYK121934Medicare PIN
KYK121936Medicare PIN
KYK121930Medicare PIN
KYK121933Medicare PIN
KYK121932Medicare PIN