Provider Demographics
NPI:1780772764
Name:MARTINEZ, GLENDA LINDON (ARNP WOMENS HEALTH)
Entity type:Individual
Prefix:MS
First Name:GLENDA
Middle Name:LINDON
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:ARNP WOMENS HEALTH
Other - Prefix:
Other - First Name:GLENDA
Other - Middle Name:
Other - Last Name:BALLARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:496 SOUTHLAND DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-1827
Mailing Address - Country:US
Mailing Address - Phone:859-288-2392
Mailing Address - Fax:859-721-3918
Practice Address - Street 1:496 SOUTHLAND DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-1827
Practice Address - Country:US
Practice Address - Phone:859-288-2425
Practice Address - Fax:859-288-7510
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYRN1062681 ARNP2810P363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100149670Medicaid
KY7100149670Medicaid