Individual
LORA MUTISO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
1306 VERSAILLES RD, SUITE 120, LEXINGTON, KY 40504-1796
(859) 259-2635
(859) 254-7874
Mailing address
1306 VERSAILLES RD, SUITE 120, LEXINGTON, KY 40504-1796
(859) 259-2635
(859) 254-7874
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
4380P
KY
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
3004380
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100384290
—
KY
Enumeration date
04/02/2007
Last updated
04/23/2020
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