Healthcare Provider Details

I. General information

NPI: 1710890934
Provider Name (Legal Business Name): MICHELLE LEE MCDONALD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 RING RD
ELIZABETHTOWN KY
42701-9454
US

IV. Provider business mailing address

2000 RING RD
ELIZABETHTOWN KY
42701-9454
US

V. Phone/Fax

Practice location:
  • Phone: 270-506-2730
  • Fax: 270-900-0704
Mailing address:
  • Phone: 270-506-2730
  • Fax: 270-900-0704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4063652
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: