Healthcare Provider Details

I. General information

NPI: 1528398260
Provider Name (Legal Business Name): LINDSEY BRENNICK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/31/2009
Last Update Date: 12/31/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10510 LA GRANGE RD FLYNN BUILDING, C/O CENTRAL STATE HOSPITAL
LOUISVILLE KY
40223-1277
US

IV. Provider business mailing address

101 W MUHAMMAD ALI BLVD
LOUISVILLE KY
40202-1423
US

V. Phone/Fax

Practice location:
  • Phone: 502-589-8600
  • Fax: 502-589-8771
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number1116828
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: