Healthcare Provider Details

I. General information

NPI: 1851237622
Provider Name (Legal Business Name): TRACI LEA LINDON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

289 BLACK GOLD BLVD
HAZARD KY
41701-2604
US

IV. Provider business mailing address

13 BROOK VW
HAZARD KY
41701-6097
US

V. Phone/Fax

Practice location:
  • Phone: 606-436-2475
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: