Healthcare Provider Details

I. General information

NPI: 1689022139
Provider Name (Legal Business Name): JANIS LEE LYDICK CASTON APRN, DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JANIS LYDICK RICKE

II. Dates (important events)

Enumeration Date: 05/25/2016
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 FLEMINGSBURG RD STE A340
MOREHEAD KY
40351-1015
US

IV. Provider business mailing address

3361 DOWNING PL
LEXINGTON KY
40517-2108
US

V. Phone/Fax

Practice location:
  • Phone: 606-207-2931
  • Fax: 606-783-0964
Mailing address:
  • Phone: 985-285-9984
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP08749
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3018761
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAP08749
License Number StateLA
# 4
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number3018761
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: