Healthcare Provider Details

I. General information

NPI: 1083597520
Provider Name (Legal Business Name): TISHA ZISKIND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2025
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 CHINOE RD
LEXINGTON KY
40502-3009
US

IV. Provider business mailing address

1015 CHINOE RD
LEXINGTON KY
40502-3009
US

V. Phone/Fax

Practice location:
  • Phone: 859-397-5002
  • Fax:
Mailing address:
  • Phone: 859-397-5002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number4043118
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: