Provider Demographics
NPI:1255999363
Name:CUSICK, CELESTA LEE (RN, MSN/INF)
Entity type:Individual
Prefix:
First Name:CELESTA
Middle Name:LEE
Last Name:CUSICK
Suffix:
Gender:F
Credentials:RN, MSN/INF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 N LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:WILMORE
Mailing Address - State:KY
Mailing Address - Zip Code:40390-1138
Mailing Address - Country:US
Mailing Address - Phone:724-456-1268
Mailing Address - Fax:
Practice Address - Street 1:701 N LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:WILMORE
Practice Address - State:KY
Practice Address - Zip Code:40390-1138
Practice Address - Country:US
Practice Address - Phone:724-456-1268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-04
Last Update Date:2019-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK127909163W00000X
KY1104010163W00000X
MS888130163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse