Healthcare Provider Details

I. General information

NPI: 1972495810
Provider Name (Legal Business Name): MR. CHRISTOPHER DEWAYNE HARBISON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2025
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13214 KNOLL WIND WAY
LOUISVILLE KY
40299-4796
US

IV. Provider business mailing address

13214 KNOLL WIND WAY
LOUISVILLE KY
40299-4796
US

V. Phone/Fax

Practice location:
  • Phone: 502-386-1223
  • Fax:
Mailing address:
  • Phone: 502-386-1223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License NumberH96-854-412
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: