Provider Demographics
NPI:1497930077
Name:BLANTON, LORI L (BA)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:L
Last Name:BLANTON
Suffix:
Gender:F
Credentials:BA
Other - Prefix:MRS
Other - First Name:LORI
Other - Middle Name:L
Other - Last Name:ROYAL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BA
Mailing Address - Street 1:4150 ALEXANDRIA PIKE STE 108
Mailing Address - Street 2:
Mailing Address - City:COLD SPRING
Mailing Address - State:KY
Mailing Address - Zip Code:41076-3500
Mailing Address - Country:US
Mailing Address - Phone:859-572-0430
Mailing Address - Fax:859-572-0163
Practice Address - Street 1:4150 ALEXANDRIA PIKE
Practice Address - Street 2:
Practice Address - City:COLD SPRING
Practice Address - State:KY
Practice Address - Zip Code:41076-3501
Practice Address - Country:US
Practice Address - Phone:859-572-0430
Practice Address - Fax:859-572-0163
Is Sole Proprietor?:No
Enumeration Date:2008-01-02
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator