Provider Demographics
NPI:1730319419
Name:USHER, RONNITA M
Entity Type:Individual
Prefix:
First Name:RONNITA
Middle Name:M
Last Name:USHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 E BROADWAY
Mailing Address - Street 2:STE. 290
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1785
Mailing Address - Country:US
Mailing Address - Phone:502-217-5134
Mailing Address - Fax:502-217-5137
Practice Address - Street 1:1941 BISHOP LN STE 900
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-1963
Practice Address - Country:US
Practice Address - Phone:502-588-8700
Practice Address - Fax:502-588-8703
Is Sole Proprietor?:No
Enumeration Date:2009-07-16
Last Update Date:2017-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1098853163W00000X
KY3006096363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY50026724OtherPASSPORT
KY7100100270Medicaid
KYK007602OtherMEDICARE
IN3000009521OtherINDIANA MEDICAID
KY3751481000OtherPASSPORT ADVANTAGE