Healthcare Provider Details

I. General information

NPI: 1578774527
Provider Name (Legal Business Name): LYNNE R HUMKEY RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 ELKHORN BEND DRIVE
MIDWAY KY
40347-9794
US

IV. Provider business mailing address

121 ELKHORN BEND DRIVE
MIDWAY KY
40347-9794
US

V. Phone/Fax

Practice location:
  • Phone: 859-422-6667
  • Fax:
Mailing address:
  • Phone: 859-422-6667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number1036176
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: