Provider Demographics
NPI:1053178731
Name:PRICE, SUSAN RENEE (APRN)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:RENEE
Last Name:PRICE
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 1:1055 HEATHCLIFF DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-2659
Mailing Address - Country:US
Mailing Address - Phone:859-200-4413
Mailing Address - Fax:
Practice Address - Street 1:1000 S LIMESTONE
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0001
Practice Address - Country:US
Practice Address - Phone:859-323-9057
Practice Address - Fax:859-323-9502
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-29
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QS1000X
KY4017241363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health