Provider Demographics
NPI:1720756919
Name:ROEDERER, ARDIS MEREDITH (APRN)
Entity Type:Individual
Prefix:
First Name:ARDIS
Middle Name:MEREDITH
Last Name:ROEDERER
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 1:1760 NICHOLASVILLE RD STE 301
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-1472
Mailing Address - Country:US
Mailing Address - Phone:859-277-8659
Mailing Address - Fax:859-277-6143
Practice Address - Street 1:1760 NICHOLASVILLE RD STE 301
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-1472
Practice Address - Country:US
Practice Address - Phone:859-277-8659
Practice Address - Fax:859-277-6143
Is Sole Proprietor?:No
Enumeration Date:2021-09-01
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3015562363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care