Provider Demographics
NPI:1801059043
Name:BOND, LISA DAWN (LPP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:DAWN
Last Name:BOND
Suffix:
Gender:F
Credentials:LPP
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:DAWN
Other - Last Name:HINKLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:161 PROSPEROUS PL
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-1898
Mailing Address - Country:US
Mailing Address - Phone:859-368-0609
Mailing Address - Fax:859-368-9767
Practice Address - Street 1:161 PROSPEROUS PL
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1898
Practice Address - Country:US
Practice Address - Phone:859-368-0609
Practice Address - Fax:859-368-9767
Is Sole Proprietor?:No
Enumeration Date:2008-07-08
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0905103T00000X
KY175264103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000689151OtherANTHEM BCBS
KY30610026Medicaid