MEDICARE: ELIZABETH SULLINS TOVAR PHD,FNP-C,PMHNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2100X	Acute Care Nurse Practitioner	666168	TX
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	5215P	KY
3	363L00000X	Nurse Practitioner	5215P	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568559268
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH SULLINS TOVAR PHD,FNP-C,PMHNP-BC

Provider Business Mailing Address
First Line	:	3150 CUSTER DR STE 101
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40517-4010
Country	:	US
Telephone Number	:	859-368-0434
Fax Number	:	859-368-0437

Provider Business Practice Location Address
First Line	:	3150 CUSTER DR STE 101
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40517-4010
Country	:	US
Telephone Number	:	859-368-0434
Fax Number	:	859-368-0437

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	02/29/2024

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Directions to “ ELIZABETH SULLINS TOVAR PHD,FNP-C,PMHNP-BC” Practice Location

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