Healthcare Provider Details

I. General information

NPI: 1386558864
Provider Name (Legal Business Name): MARSHALL LIFESTYLE MEDICINE, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 ROMANY RD
LEXINGTON KY
40502-2403
US

IV. Provider business mailing address

750 SHAKER DR APT 304
LEXINGTON KY
40504-3726
US

V. Phone/Fax

Practice location:
  • Phone: 859-300-3247
  • Fax:
Mailing address:
  • Phone: 859-382-1500
  • Fax: 859-368-8920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: JOYCE JOHNSON
Title or Position: DIRECTOR OF CLINICAL OPERATIONS
Credential: CMA (AAMA)
Phone: 859-382-1500