Provider Demographics
NPI:1417939935
Name:MOLENAAR, LORI SUSAN (ARNP)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:SUSAN
Last Name:MOLENAAR
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1013 STOWBRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40515-5073
Mailing Address - Country:US
Mailing Address - Phone:859-271-0245
Mailing Address - Fax:859-323-1119
Practice Address - Street 1:U.K. UNIVERSITY HEALTH SERVICE 740 S. LIMESTONE ST
Practice Address - Street 2:KY CLINIC SUITE 163-B
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0001
Practice Address - Country:US
Practice Address - Phone:859-323-5511
Practice Address - Fax:859-323-1119
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3002423364SP0807X
KYKY 2423S363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No364SP0807XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Adolescent