Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 46177 | KY |
NPI | 1982925004 |
---|---|
Provider Name | Lindsay B Blackmon |
First Address | Bardstown, KY 40004-1142 |
Second Address | Bardstown, KY 40004-1142 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2010 |
Last Update Date | 02/07/2013 |