Provider Demographics
NPI:1326034950
Name:MARTIN, LYNETTE K (MD)
Entity Type:Individual
Prefix:DR
First Name:LYNETTE
Middle Name:K
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LYNETTE
Other - Middle Name:KAYONO
Other - Last Name:TUN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2200 E. PARRISH AVE
Mailing Address - Street 2:BLDG B, STE 101
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-1449
Mailing Address - Country:US
Mailing Address - Phone:270-683-3232
Mailing Address - Fax:270-852-1600
Practice Address - Street 1:2200 E. PARRISH AVE
Practice Address - Street 2:BLDG B, STE. 101
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-1449
Practice Address - Country:US
Practice Address - Phone:270-683-3232
Practice Address - Fax:270-852-1600
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY34360208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY00000051443OtherID BLUE CROSS INSURANCE
KY50004897OtherPASS-PORT NON-PARTCIPATE
00000051443OtherBLUE CROSS
KY64343601Medicaid
KY50004897OtherPASS-PORT NON-PARTCIPATE
KY64343601Medicaid