Provider Demographics
NPI:1922388818
Name:ROUNSAVALL, KELLY PREASMYER (CRNA)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:PREASMYER
Last Name:ROUNSAVALL
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:JEAN
Other - Last Name:PREASMYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 34748
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40232-4748
Mailing Address - Country:US
Mailing Address - Phone:502-473-2132
Mailing Address - Fax:502-459-0923
Practice Address - Street 1:4000 KRESGE WAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4605
Practice Address - Country:US
Practice Address - Phone:502-473-2132
Practice Address - Fax:502-459-0923
Is Sole Proprietor?:No
Enumeration Date:2011-08-23
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1114347163W00000X
KY3007128367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYK029270OtherMEDICARE PTAN
KY7100181800OtherKENTUCKY MEDICAID