Provider Demographics
NPI:1225875784
Name:CLISE, NATALIE KATHLEEN (APRN)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:KATHLEEN
Last Name:CLISE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 WILL ANDREW CT
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-2999
Mailing Address - Country:US
Mailing Address - Phone:859-230-2842
Mailing Address - Fax:
Practice Address - Street 1:740 S LIMESTONE STE L304
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0001
Practice Address - Country:US
Practice Address - Phone:859-323-6494
Practice Address - Fax:859-257-2573
Is Sole Proprietor?:No
Enumeration Date:2024-07-11
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1158547163WC0200X
KY4029028363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine