Provider Demographics
NPI:1609182443
Name:RUSSELL, DENISE (ARNP)
Entity Type:Individual
Prefix:MS
First Name:DENISE
Middle Name:
Last Name:RUSSELL
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 1:1700 NICHOLASVILLE RD STE 701
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-1467
Mailing Address - Country:US
Mailing Address - Phone:859-278-0396
Mailing Address - Fax:859-277-5414
Practice Address - Street 1:1700 NICHOLASVILLE RD STE 701
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-1467
Practice Address - Country:US
Practice Address - Phone:859-278-0396
Practice Address - Fax:859-277-5414
Is Sole Proprietor?:No
Enumeration Date:2010-08-30
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY6441P363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100142080Medicaid