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General NPI Number Information
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NPI Number | 1568105021
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Entity Type | Organization
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Legal Business Name | RISE AND WALK PSYCHIATRIC SERVICES LLC
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Dates
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Enumeration Date | 04/13/2022
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Last Update Date | 04/13/2022
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Provider Practice Location Address
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Address Line | 10501 MEETING ST # 201
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City | PROSPECT
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State | KY
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Zip | 40059-7591
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Country | US
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Telephone | 502-408-4977
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Fax |
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Provider Business Mailing Address
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Address Line | 10501 MEETING ST # 201
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City | PROSPECT
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State | KY
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Zip | 40059-7591
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Country | US
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Telephone | 502-408-4977
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Fax |
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Authorized Official
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Title or Position | OWNER/PMHNP-BC
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Name | JENNIFER OBANNON
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Credential | APRN
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Telephone | 502-408-4977
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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 |
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License Number State |
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