Provider Demographics
NPI:1205909330
Name:RICE, SUSAN SMITH (APRN)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:SMITH
Last Name:RICE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1219 NORTH MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BEAVER DAM
Mailing Address - State:KY
Mailing Address - Zip Code:42320
Mailing Address - Country:US
Mailing Address - Phone:270-274-0638
Mailing Address - Fax:270-274-5600
Practice Address - Street 1:1219 NORTH MAIN ST
Practice Address - Street 2:NORSWORTHY MEDICAL ASSOC., PSC
Practice Address - City:BEAVER DAM
Practice Address - State:KY
Practice Address - Zip Code:42320
Practice Address - Country:US
Practice Address - Phone:270-274-0638
Practice Address - Fax:270-274-5600
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3830P363L00000X, 363LF0000X
KY3003830363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78008190Medicaid
KY1205909330Medicaid
KY78008190Medicaid
1317210Medicare PIN