Healthcare Provider Details

I. General information

NPI: 1992992572
Provider Name (Legal Business Name): LON LAFFERTY MD PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2007
Last Update Date: 06/13/2023
Certification Date: 06/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RT 40 EAST BLACKLOG RD
INEZ KY
41224
US

IV. Provider business mailing address

PO BOX 1304
INEZ KY
41224-1304
US

V. Phone/Fax

Practice location:
  • Phone: 606-298-7405
  • Fax: 606-298-3284
Mailing address:
  • Phone: 606-298-4705
  • Fax: 606-298-3284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number24313
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4341P
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LON E LAFFERTY
Title or Position: OWNER
Credential: MD
Phone: 606-298-7405