Healthcare Provider Details

I. General information

NPI: 1326034950
Provider Name (Legal Business Name): LYNETTE K. MARTIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LYNETTE KAYONO TUN M.D.

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 09/18/2023
Certification Date: 09/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 E. PARRISH AVE BLDG B, STE. 101
OWENSBORO KY
42303-1449
US

IV. Provider business mailing address

2200 E. PARRISH AVE BLDG B, STE 101
OWENSBORO KY
42303-1449
US

V. Phone/Fax

Practice location:
  • Phone: 270-683-3232
  • Fax: 270-852-1600
Mailing address:
  • Phone: 270-683-3232
  • Fax: 270-852-1600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number34360
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: