Individual
JACLYN LUNSFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
200 MEDICAL VILLAGE DR, EDGEWOOD, KY 41017
(859) 301-5901
(859) 301-5940
Mailing address
PO BOX 635283, CINCINNATI, OH 45263-5283
(859) 301-5901
(859) 301-5940
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0150184
—
OH
05
—
7100388160
—
KY
Enumeration date
10/01/2015
Last updated
08/30/2018
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