Provider Demographics
NPI:1245583236
Name:DUPONT, LYNNELL (MD)
Entity Type:Individual
Prefix:
First Name:LYNNELL
Middle Name:
Last Name:DUPONT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LYNNELL
Other - Middle Name:
Other - Last Name:DUPONT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:690 MASON HEADLEY #210
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504
Mailing Address - Country:US
Mailing Address - Phone:859-457-1230
Mailing Address - Fax:
Practice Address - Street 1:690 MASON HEADLEY RD APT 210
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-2337
Practice Address - Country:US
Practice Address - Phone:859-457-1230
Practice Address - Fax:888-728-9038
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-16
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY27659208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY8592859399Medicaid