Healthcare Provider Details

I. General information

NPI: 1699809210
Provider Name (Legal Business Name): MRS. KATHY R. LILLY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1139 BRIARWOOD DR
LAWRENCEBURG KY
40342-9469
US

IV. Provider business mailing address

1139 BRIARWOOD DR
LAWRENCEBURG KY
40342-9469
US

V. Phone/Fax

Practice location:
  • Phone: 502-839-8282
  • Fax:
Mailing address:
  • Phone: 502-839-8282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: