Provider Demographics
NPI:1265932248
Name:LIGHTNER, KIMBERLY DAWN (LMT)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:DAWN
Last Name:LIGHTNER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MRS
Other - First Name:KIMBERLY
Other - Middle Name:DAWN
Other - Last Name:COGHLAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2230 GRANDVIEW DR
Mailing Address - Street 2:
Mailing Address - City:FORT MITCHELL
Mailing Address - State:KY
Mailing Address - Zip Code:41017-1643
Mailing Address - Country:US
Mailing Address - Phone:859-628-7167
Mailing Address - Fax:
Practice Address - Street 1:2230 GRANDVIEW DR
Practice Address - Street 2:
Practice Address - City:FORT MITCHELL
Practice Address - State:KY
Practice Address - Zip Code:41017-1643
Practice Address - Country:US
Practice Address - Phone:859-628-7167
Practice Address - Fax:859-628-7167
Is Sole Proprietor?:No
Enumeration Date:2018-02-16
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY107740225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist