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General NPI Number Information
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NPI Number | 1114263100
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Entity Type | Organization
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Legal Business Name | WISDOM KEY BEHAVIORAL HEALTH SERVICES INC
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Dates
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Enumeration Date | 12/18/2012
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Last Update Date | 02/28/2014
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Provider Practice Location Address
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Address Line | 1239 WOODLAND DR SUITE 110
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City | ELIZABETHTOWN
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State | KY
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Zip | 42701-2770
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Country | US
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Telephone | 270-900-0094
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Fax | 270-900-0430
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Provider Business Mailing Address
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Address Line | 56 DAWSON RD
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City | RADCLIFF
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State | KY
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Zip | 40160-9755
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Country | US
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Telephone | 270-900-0094
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Fax | 270-900-0430
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Authorized Official
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Title or Position | MANAGER
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Name | NANCY WILLIAMS
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Credential | PMHNP-BC
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Telephone | 270-900-0094
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 3006237
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License Number State | KY
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