Healthcare Provider Details

I. General information

NPI: 1730953324
Provider Name (Legal Business Name): PRISM WELLNESS SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2023
Last Update Date: 04/10/2025
Certification Date: 04/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

989 GOVERNORS LN STE 140
LEXINGTON KY
40513-1174
US

IV. Provider business mailing address

989 GOVERNORS LN STE 140
LEXINGTON KY
40513-1174
US

V. Phone/Fax

Practice location:
  • Phone: 859-494-9984
  • Fax: 859-484-7186
Mailing address:
  • Phone: 859-494-9984
  • Fax: 833-973-4422

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: HOYT NOBLE
Title or Position: PMHNP / CEO
Credential: APRN
Phone: 859-494-9984