Healthcare Provider Details

I. General information

NPI: 1487932950
Provider Name (Legal Business Name): LYNDSIE ALBRIGHT BEANBLOSSOM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2011
Last Update Date: 08/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 WATCH HILL LN
LOUISVILLE KY
40245-2200
US

IV. Provider business mailing address

420 WATCH HILL LN
LOUISVILLE KY
40245-2200
US

V. Phone/Fax

Practice location:
  • Phone: 502-645-4331
  • Fax:
Mailing address:
  • Phone: 502-645-4331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: