Healthcare Provider Details

I. General information

NPI: 1164348298
Provider Name (Legal Business Name): OGHOSA CHRISTIAN IYEN NURSE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3213 CHERRY MEADOW PATH
LEXINGTON KY
40509-8548
US

IV. Provider business mailing address

3213 CHERRY MEADOW PATH
LEXINGTON KY
40509-8548
US

V. Phone/Fax

Practice location:
  • Phone: 859-948-0055
  • Fax:
Mailing address:
  • Phone: 859-948-0055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number4019985
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: