Healthcare Provider Details

I. General information

NPI: 1245174283
Provider Name (Legal Business Name): AWA CISSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 LEXINGTON RD
VERSAILLES KY
40383-1738
US

IV. Provider business mailing address

3779 KENSINGTON DR
DANVILLE IN
46122-6000
US

V. Phone/Fax

Practice location:
  • Phone: 859-251-4700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number28245308A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: