Healthcare Provider Details

I. General information

NPI: 1194156596
Provider Name (Legal Business Name): WESTERN KENTUCKY BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2013
Last Update Date: 08/18/2023
Certification Date: 08/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2363 LYCE DUNCAN RD
DIXON KY
42409-9761
US

IV. Provider business mailing address

2363 LYCE DUNCAN RD
DIXON KY
42409-9761
US

V. Phone/Fax

Practice location:
  • Phone: 270-213-3635
  • Fax: 270-213-5015
Mailing address:
  • Phone: 270-213-0094
  • Fax: 270-693-9499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: REGINA ELISE ROBISON
Title or Position: OWNER
Credential: APRN
Phone: 270-213-3635