Healthcare Provider Details

I. General information

NPI: 1639624224
Provider Name (Legal Business Name): ALISHA R RISEN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2016
Last Update Date: 03/02/2023
Certification Date: 03/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 JAMESTOWN ST
COLUMBIA KY
42728-1010
US

IV. Provider business mailing address

1301 N RACE ST
GLASGOW KY
42141-3454
US

V. Phone/Fax

Practice location:
  • Phone: 703-844-7642
  • Fax: 270-384-2828
Mailing address:
  • Phone: 270-651-4444
  • Fax: 270-651-4892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number3010666
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code364SP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist
License Number3010666
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: