Healthcare Provider Details

I. General information

NPI: 1568791523
Provider Name (Legal Business Name): HIGHLAND HEALTH CENTER, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2009
Last Update Date: 03/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 BARRET AVE
LOUISVILLE KY
40204-1750
US

IV. Provider business mailing address

720 BARRET AVE
LOUISVILLE KY
40204-1750
US

V. Phone/Fax

Practice location:
  • Phone: 502-582-5555
  • Fax: 502-582-5556
Mailing address:
  • Phone: 502-582-5555
  • Fax: 502-582-5556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License Number3004162
License Number StateKY

VIII. Authorized Official

Name: DR. BLAINE LISNER
Title or Position: ATTENDING PHYSICIAN
Credential: M.D.
Phone: 502-582-5555