Healthcare Provider Details

I. General information

NPI: 1477683191
Provider Name (Legal Business Name): DONITA DILLON LIGHTNER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 05/02/2022
Certification Date: 05/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

149 OLD TOWNE WALK APT 8101
LEXINGTON KY
40511-2197
US

IV. Provider business mailing address

149 OLD TOWNE WALK APT. 8101
LEXINGTON KY
40511-2020
US

V. Phone/Fax

Practice location:
  • Phone: 859-576-9056
  • Fax:
Mailing address:
  • Phone: 859-576-9056
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number45359
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: