Provider Demographics
NPI:1477364180
Name:ROSE, NONTASCHA GWEN (MSN, APRN FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:NONTASCHA
Middle Name:GWEN
Last Name:ROSE
Suffix:
Gender:F
Credentials:MSN, APRN FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 ROSE BEND RD
Mailing Address - Street 2:
Mailing Address - City:CAMPTON
Mailing Address - State:KY
Mailing Address - Zip Code:41301-9435
Mailing Address - Country:US
Mailing Address - Phone:606-495-5415
Mailing Address - Fax:
Practice Address - Street 1:40 MAIN STREET
Practice Address - Street 2:SUITE B
Practice Address - City:CAMPTON
Practice Address - State:KY
Practice Address - Zip Code:41301
Practice Address - Country:US
Practice Address - Phone:606-668-9076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-14
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1141107163W00000X
KY4034165363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse