Healthcare Provider Details

I. General information

NPI: 1780199638
Provider Name (Legal Business Name): ALYSSA FLEMING APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 FALCON DR
MT STERLING KY
40353-9792
US

IV. Provider business mailing address

3348 ORCHARD GRASS RD
LEXINGTON KY
40509-8642
US

V. Phone/Fax

Practice location:
  • Phone: 859-497-5000
  • Fax:
Mailing address:
  • Phone: 859-967-6485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3011929
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number3011929
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: