Healthcare Provider Details

I. General information

NPI: 1902144421
Provider Name (Legal Business Name): LISA PERINO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2013
Last Update Date: 01/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 REGENCY RD SUITE 101
LEXINGTON KY
40503-2914
US

IV. Provider business mailing address

2401 REGENCY RD SUITE 101
LEXINGTON KY
40503-2914
US

V. Phone/Fax

Practice location:
  • Phone: 859-309-0309
  • Fax: 859-309-0914
Mailing address:
  • Phone: 859-309-0309
  • Fax: 859-309-0914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number3007588
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: