Provider Demographics
NPI:1639813918
Name:KOLSON, ROXANNE SERVICES (CCP, LP)
Entity Type:Individual
Prefix:
First Name:ROXANNE
Middle Name:SERVICES
Last Name:KOLSON
Suffix:
Gender:F
Credentials:CCP, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 W MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:NICHOLASVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40356-1241
Mailing Address - Country:US
Mailing Address - Phone:859-552-5690
Mailing Address - Fax:
Practice Address - Street 1:311 W MAPLE ST
Practice Address - Street 2:
Practice Address - City:NICHOLASVILLE
Practice Address - State:KY
Practice Address - Zip Code:40356-1241
Practice Address - Country:US
Practice Address - Phone:859-552-5690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-23
Last Update Date:2022-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006034698242T00000X
NJ25M10010700242T00000X
CT000067242T00000X
GA178242T00000X
NY000350242T00000X
TX0000123242T00000X
242T00000X
NC100000117242T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes242T00000XTechnologists, Technicians & Other Technical Service ProvidersPerfusionist