Healthcare Provider Details

I. General information

NPI: 1447477625
Provider Name (Legal Business Name): LAURA E HUMMEL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 PASADENA DR
LEXINGTON KY
40503-2925
US

IV. Provider business mailing address

2416 REGENCY ROAD
LEXINGTON KY
40503-2954
US

V. Phone/Fax

Practice location:
  • Phone: 859-278-1316
  • Fax: 859-276-3847
Mailing address:
  • Phone: 859-278-1316
  • Fax: 859-276-3847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD29456
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number45679
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberMD200113
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: