Organization
LOVELY VEINS HOLISTIC LABORATORY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. BRIDGET NICOLE GORDON A.S. FMP, CCMA, HCM, (CEO/ CLINICAL DIRECTOR)
(502) 922-6653
Entity
Organization
Contact information
Practice address
212 N 2ND ST STE 100, RICHMOND, KY 40475-1408
(502) 922-6653
Mailing address
6844 BARDSTOWN RD UNIT 2144, LOUISVILLE, KY 40291-3050
(502) 922-6653
Taxonomy
Speciality
Code
Description
License number
State
246RP1900X
Phlebotomy Technician
Primary
—
—
305S00000X
Point of Service
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
18D2277377
CLIA
KY
Enumeration date
08/08/2023
Last updated
06/20/2026
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