Healthcare Provider Details

I. General information

NPI: 1891874780
Provider Name (Legal Business Name): JOHN C VINSON IV APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 10/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 MONARCH ST SUITE 200
LEXINGTON KY
40513-1843
US

IV. Provider business mailing address

1030 MONARCH ST SUITE 200
LEXINGTON KY
40513-1843
US

V. Phone/Fax

Practice location:
  • Phone: 859-296-3141
  • Fax: 859-296-3144
Mailing address:
  • Phone: 859-296-3141
  • Fax: 859-296-3144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number4981P
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: