Provider Demographics
NPI:1326807348
Name:CARL, LYNETTE (MD)
Entity Type:Individual
Prefix:
First Name:LYNETTE
Middle Name:
Last Name:CARL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 CROWN POINT EST
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-7531
Mailing Address - Country:US
Mailing Address - Phone:859-983-6894
Mailing Address - Fax:
Practice Address - Street 1:350 CROWN POINT EST
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-7531
Practice Address - Country:US
Practice Address - Phone:859-983-6894
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-14
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY222Q00000X
222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist