Individual
TARA BISSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.AC.
Contact information
Practice address
SOURCE ON HIGH 518 E. HIGH STREET, LEXINGTON, KY 40502
(859) 202-8841
Mailing address
PO BOX 614, LEXINGTON, KY 40588-0614
(859) 202-8841
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
TAC90
KY
Other
Enumeration date
06/17/2015
Last updated
04/20/2017
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