Healthcare Provider Details

I. General information

NPI: 1487574034
Provider Name (Legal Business Name): MR. STEPHEN SISLER II
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 S LIMESTONE ST
LEXINGTON KY
40536-0001
US

IV. Provider business mailing address

245 RAILROAD ST
HANGING ROCK OH
45638-9017
US

V. Phone/Fax

Practice location:
  • Phone: 859-257-1000
  • Fax:
Mailing address:
  • Phone: 740-646-8202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN.553159
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: