Provider Demographics
NPI:1861578155
Name:WASHINGTON, ROY BERNARD (ARNP)
Entity type:Individual
Prefix:MR
First Name:ROY
Middle Name:BERNARD
Last Name:WASHINGTON
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:927 FAIRVIEW CIR
Mailing Address - Street 2:
Mailing Address - City:RADCLIFF
Mailing Address - State:KY
Mailing Address - Zip Code:40160-2327
Mailing Address - Country:US
Mailing Address - Phone:270-312-1753
Mailing Address - Fax:
Practice Address - Street 1:927 FAIRVIEW CIR
Practice Address - Street 2:
Practice Address - City:RADCLIFF
Practice Address - State:KY
Practice Address - Zip Code:40160-2327
Practice Address - Country:US
Practice Address - Phone:270-312-1753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY363LA2200X363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health