Healthcare Provider Details

I. General information

NPI: 1619889607
Provider Name (Legal Business Name): WYNONNA CLINE LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 N MAIN ST
STANTON KY
40380-2175
US

IV. Provider business mailing address

435 OAK RIDGE RD
CLAY CITY KY
40312-9048
US

V. Phone/Fax

Practice location:
  • Phone: 502-667-0568
  • Fax:
Mailing address:
  • Phone: 502-667-0568
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number310661
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: