# GENESIS WELLNESS CENTER PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1851166813
- **Authorized official:** DR. LISA C GAINES APRN (OWNER)
- **Authorized official phone:** (502) 644-9162

## Contact information

- **Practice address:** 3000 S 5TH ST, LOUISVILLE, KY 40208-1312
- **Practice address phone:** (502) 644-9162
- **Practice address fax:** (502) 390-0330
- **Mailing address:** 4507 MEADOWLARK MANOR LN, LOUISVILLE, KY 40245-2702
- **Mailing address phone:** (502) 644-9162
- **Mailing address fax:** (502) 390-0330

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LC1500X | Community Health Nurse Practitioner | — | NULL | — |
| 363LC1500X | Community Health Nurse Practitioner | — | — | — |
| 363LF0000X | Family Nurse Practitioner | — | NULL | — |
| 363LF0000X | Family Nurse Practitioner | — | — | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 11/20/2023
- **Last updated:** 07/11/2024