Healthcare Provider Details

I. General information

NPI: 1295967792
Provider Name (Legal Business Name): ALISON CONNELL ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2009
Last Update Date: 08/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

62 MERCY CT
IRVINE KY
40336-1331
US

IV. Provider business mailing address

155 GOODRICH AVE
LEXINGTON KY
40503-1911
US

V. Phone/Fax

Practice location:
  • Phone: 606-723-5142
  • Fax:
Mailing address:
  • Phone: 859-533-3866
  • Fax: 859-257-8478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1052949
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: