Provider Demographics
NPI:1699809210
Name:LILLY, KATHY R
Entity Type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:R
Last Name:LILLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1139 BRIARWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40342-9469
Mailing Address - Country:US
Mailing Address - Phone:502-839-8282
Mailing Address - Fax:
Practice Address - Street 1:1139 BRIARWOOD DR
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:KY
Practice Address - Zip Code:40342-9469
Practice Address - Country:US
Practice Address - Phone:502-839-8282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor