Provider Demographics
NPI:1013059559
Name:BLISS, DEBORAH ELAINE (ACNP)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ELAINE
Last Name:BLISS
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 THOMAS MORE PARKWAY
Mailing Address - Street 2:ST. ELIZABETH HEALTHCARE, SUITE 280
Mailing Address - City:CRESTVIEW HILLS
Mailing Address - State:KY
Mailing Address - Zip Code:41017
Mailing Address - Country:US
Mailing Address - Phone:859-426-0800
Mailing Address - Fax:859-578-0222
Practice Address - Street 1:1 MEDICAL VILLAGE DRIVE
Practice Address - Street 2:ST. ELIZABETH HEALTHCARE
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41017-3403
Practice Address - Country:US
Practice Address - Phone:859-301-2000
Practice Address - Fax:859-301-6900
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYNP-3855P363LA2100X
OHCOA.06835-NP363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHNP-06835OtherOHIO NP LICENSE