Healthcare Provider Details

I. General information

NPI: 1518615152
Provider Name (Legal Business Name): HEALING WELL INTEGRATIVE COMMUNITY HEALTHCARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2022
Last Update Date: 08/11/2024
Certification Date: 08/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1426 N FORBES RD
LEXINGTON KY
40511-8995
US

IV. Provider business mailing address

296 MEADOW VALLEY RD
LEXINGTON KY
40511-8788
US

V. Phone/Fax

Practice location:
  • Phone: 859-492-9864
  • Fax:
Mailing address:
  • Phone: 859-492-9864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CHARLETTE DENIENE THOMPSON
Title or Position: CEO
Credential: APRN
Phone: 859-492-9864