Healthcare Provider Details

I. General information

NPI: 1841279908
Provider Name (Legal Business Name): KIMBERLY H LAWLESS AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2006
Last Update Date: 06/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 GREENBRIAR DR SUITE A
CAMPBELLSVILLE KY
42718-9615
US

IV. Provider business mailing address

105 GREENBRIAR DR SUITE A
CAMPBELLSVILLE KY
42718-9615
US

V. Phone/Fax

Practice location:
  • Phone: 270-465-3595
  • Fax: 859-259-4063
Mailing address:
  • Phone: 270-465-3595
  • Fax: 859-259-4063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number117
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number279
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: