Healthcare Provider Details

I. General information

NPI: 1811657836
Provider Name (Legal Business Name): RACHEL MACKENZIE LIPSCOMB APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2021
Last Update Date: 03/17/2022
Certification Date: 03/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7766 EWING BLVD
FLORENCE KY
41042-7537
US

IV. Provider business mailing address

PO BOX 635283
CINCINNATI OH
45263-5283
US

V. Phone/Fax

Practice location:
  • Phone: 859-371-1153
  • Fax: 859-647-5113
Mailing address:
  • Phone: 859-371-1153
  • Fax: 859-647-5113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3017149
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3017149
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: