Provider Demographics
NPI:1518001437
Name:LEARIE LINDSAY
Entity Type:Organization
Organization Name:LEARIE LINDSAY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOSSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-893-5502
Mailing Address - Street 1:6500 PRESTON HWY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40219-1820
Mailing Address - Country:US
Mailing Address - Phone:502-893-5502
Mailing Address - Fax:502-964-0380
Practice Address - Street 1:6500 PRESTON HWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40219-1820
Practice Address - Country:US
Practice Address - Phone:502-893-5502
Practice Address - Fax:502-964-0380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY50935208000000X
363A00000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1049802OtherPASSPORT
KY1072557OtherPASSPORT
KY1049810OtherPASSPORT
KY1049804OtherPASSPORT
KY1049813OtherPASSPORT
KY1049803OtherPASSPORT
KY1049812OtherPASSPORT
KY64175110Medicaid
KY1072559OtherPASSPORT
KY1072558OtherPASSPORT
KY1104973OtherPASSPORT
KY64170442Medicaid
KY64180623Medicaid
KY1104978OtherPASSPORT
KY3433OtherANTHEM
KY64327810Medicaid
KY65922296Medicaid
KYF06039Medicare UPIN
KY64175110Medicaid
KY64170442Medicaid