Provider Demographics
NPI:1396461109
Name:LAWRENCE, RACHEL GRACE
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:GRACE
Last Name:LAWRENCE
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 1:1709 CLIFF RIDGE CT # A
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-9161
Mailing Address - Country:US
Mailing Address - Phone:706-386-8776
Mailing Address - Fax:
Practice Address - Street 1:1709 CLIFF RIDGE CT # A
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-9161
Practice Address - Country:US
Practice Address - Phone:706-386-8776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-13
Last Update Date:2022-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist