Healthcare Provider Details

I. General information

NPI: 1437028743
Provider Name (Legal Business Name): DANIEL SCOTT NISWONGER LPP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

2327 LIME KILN LN
LOUISVILLE KY
40222-3422
US

IV. Provider business mailing address

6705 WILD FOX LN
PROSPECT KY
40059-9479
US

V. Phone/Fax

Practice location:
  • Phone: 502-414-4557
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number295279
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: