Healthcare Provider Details

I. General information

NPI: 1184670325
Provider Name (Legal Business Name): LYDIA C. SAMPLES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 VERSAILLES RD
FRANKFORT KY
40601-3857
US

IV. Provider business mailing address

4350 HAMILTON CLEVES RD
CLEVES OH
45002-9343
US

V. Phone/Fax

Practice location:
  • Phone: 502-695-3946
  • Fax:
Mailing address:
  • Phone: 513-215-6400
  • Fax: 513-215-6401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35069396
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number37175
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: