Healthcare Provider Details

I. General information

NPI: 1770545899
Provider Name (Legal Business Name): VICKI L. HISLE MSN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 09/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

890 RICHMOND PLZ
RICHMOND KY
40475-2564
US

IV. Provider business mailing address

254 SOLAR DR
MOUNT VERNON KY
40456-6499
US

V. Phone/Fax

Practice location:
  • Phone: 859-623-5155
  • Fax: 859-623-9924
Mailing address:
  • Phone: 606-256-8362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3630P
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: