Individual
LYDIA C. SAMPLES MATTISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
601 VERSAILLES RD, FRANKFORT, KY 40601-3857
(502) 695-3946
Mailing address
6101 BLUE LAGOON DR STE 200, MIAMI, FL 33126-3168
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
35069396
OH
207Q00000X
Family Medicine Physician
Primary
37175
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01079668A
STATE MEDICAL LICENSE
IN
01
—
35.069396
STATE MEDICAL LICENSE
OH
01
—
37175
STATE MEDICAL LICENSE
KY
05
—
64053473
—
KY
Enumeration date
05/26/2006
Last updated
02/11/2026
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