Provider Demographics
NPI:1841077716
Name:LOPEZ, ISELA
Entity type:Individual
Prefix:
First Name:ISELA
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2161 LEXINGTON ROAD
Mailing Address - Street 2:1ST FLOOR SUITE 5
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-7952
Mailing Address - Country:US
Mailing Address - Phone:859-626-7794
Mailing Address - Fax:859-626-4420
Practice Address - Street 1:2161 LEXINGTON ROAD
Practice Address - Street 2:1ST FLOOR SUITE 5
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-7952
Practice Address - Country:US
Practice Address - Phone:859-626-7794
Practice Address - Fax:859-626-4420
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-13
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4007644363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily