Healthcare Provider Details

I. General information

NPI: 1568383685
Provider Name (Legal Business Name): THE OTHER SIDE PSYCHIATRIC SERVICES,PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 HIGHWAY 22 E
OWENTON KY
40359-9041
US

IV. Provider business mailing address

PO BOX 36
OWENTON KY
40359-0036
US

V. Phone/Fax

Practice location:
  • Phone: 502-557-0776
  • Fax:
Mailing address:
  • Phone: 502-557-0776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. LABRISKA FAY HUMPHREY
Title or Position: PMHNP-BC
Credential: MSN,APRN,PMHNP-BC
Phone: 502-557-0776