Basic Information
| Provider Information | |||||||||
| NPI: | 1205429933 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RAYMER | ||||||||
| FirstName: | KERRI | ||||||||
| MiddleName: | MEAGAN | ||||||||
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| Credential: | IBCLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 441 LONG BRANCH LN | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405118889 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8595828654 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2400 GREATSTONE PT | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405043274 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593236211 | ||||||||
| FaxNumber: | 8592575013 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/13/2021 | ||||||||
| LastUpdateDate: | 02/13/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | 2046581 | KY | N | Nursing Service Providers | Licensed Practical Nurse | 174N00000X | L-302394 | Y | Other Service Providers | Lactation Consultant, Non-RN |
No ID Information.