Healthcare Provider Details

I. General information

NPI: 1164217980
Provider Name (Legal Business Name): SLOANE ALEXANDRA CISSELL FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2922 HILLSPRING RD
PLEASUREVILLE KY
40057-8723
US

IV. Provider business mailing address

2922 HILLSPRING RD
PLEASUREVILLE KY
40057-8723
US

V. Phone/Fax

Practice location:
  • Phone: 502-906-6470
  • Fax: 502-906-6470
Mailing address:
  • Phone: 502-906-6470
  • Fax: 502-906-6470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4037811
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: