Healthcare Provider Details

I. General information

NPI: 1265202055
Provider Name (Legal Business Name): LORYN MCKENZIE FORNEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2024
Last Update Date: 09/10/2026
Certification Date: 01/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 LEXINGTON AVE
ASHLAND KY
41101-2843
US

IV. Provider business mailing address

2201 LEXINGTON AVE
ASHLAND KY
41101-2843
US

V. Phone/Fax

Practice location:
  • Phone: 606-408-6008
  • Fax: 606-408-6825
Mailing address:
  • Phone: 606-408-8006
  • Fax: 606-408-6825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberTC068
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: