Healthcare Provider Details

I. General information

NPI: 1073749727
Provider Name (Legal Business Name): ELIZABETH RUDISELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH PARKER PSY.D.

II. Dates (important events)

Enumeration Date: 06/09/2009
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 LEESTOWN RD
LEXINGTON KY
40511-1052
US

IV. Provider business mailing address

2250 LEESTOWN RD
LEXINGTON KY
40511-1052
US

V. Phone/Fax

Practice location:
  • Phone: 859-233-4511
  • Fax:
Mailing address:
  • Phone: 859-233-4511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number172177
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: