Provider Demographics
NPI:1356778237
Name:KEITH-WEISS, RACHEL (ARNP, PHD)
Entity type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:
Last Name:KEITH-WEISS
Suffix:
Gender:F
Credentials:ARNP, PHD
Other - Prefix:DR
Other - First Name:RACHEL
Other - Middle Name:
Other - Last Name:KEITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN, PHD
Mailing Address - Street 1:580 S PRESTON ST
Mailing Address - Street 2:BAXTER II RM 204D
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1756
Mailing Address - Country:US
Mailing Address - Phone:502-852-4211
Mailing Address - Fax:
Practice Address - Street 1:580 S PRESTON ST
Practice Address - Street 2:BAXTER II RM 204D
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1756
Practice Address - Country:US
Practice Address - Phone:502-852-4211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-09
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3008100363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health