Basic Information
Provider Information
NPI: 1518242445
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: JONES
FirstName: MICHAEL
MiddleName: MARTIN
NamePrefix: DR.
NameSuffix:  
Credential: AU.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1720 NICHOLASVILLE RD STE 500
Address2:  
City: LEXINGTON
State: KY
PostalCode: 405031487
CountryCode: US
TelephoneNumber: 8592781114
FaxNumber: 8592770541
Practice Location
Address1: 1720 NICHOLASVILLE RD STE 500
Address2:  
City: LEXINGTON
State: KY
PostalCode: 405031487
CountryCode: US
TelephoneNumber: 8592781114
FaxNumber: 8592770541
Other Information
ProviderEnumerationDate: 10/11/2011
LastUpdateDate: 07/21/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
231H00000X174221KYN Speech, Language and Hearing Service ProvidersAudiologist 
231H00000X173946KYY Speech, Language and Hearing Service ProvidersAudiologist 

No ID Information.


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