Healthcare Provider Details

I. General information

NPI: 1437419827
Provider Name (Legal Business Name): GARI MICHELLE KISER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2012
Last Update Date: 06/15/2023
Certification Date: 06/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 12TH ST
CLAY CITY KY
40312-8979
US

IV. Provider business mailing address

309 SPANGLER DRIVE KENTUCKY RIVER FOOTHILLS DEVELOPMENTAL COUNCIL
RICHMOND KY
40475
US

V. Phone/Fax

Practice location:
  • Phone: 606-663-9011
  • Fax:
Mailing address:
  • Phone: 606-663-9011
  • Fax: 606-663-9012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number3007406
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3007406
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: