Healthcare Provider Details

I. General information

NPI: 1912139437
Provider Name (Legal Business Name): CLARISSA JILL SEWELL ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2009
Last Update Date: 11/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 ROSE STREET MARKEY CANCER CTR ROACH BUILDING, CC301
LEXINGTON KY
40536-0001
US

IV. Provider business mailing address

800 ROSE STREET MARKEY CANCER CTR ROACH BUILDING, CC301
LEXINGTON KY
40536-0001
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-6792
  • Fax: 859-323-8990
Mailing address:
  • Phone: 859-323-6792
  • Fax: 859-323-8990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3001633
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: