Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 25573 | KY |
N | 2080A0000X | Adolescent Medicine | 25573 | KY |
NPI | 1255328084 |
---|---|
Provider Name | Dr. Lorraine A Rust-Killeen |
First Address | Louisville, KY 40223-2907 |
Second Address | Louisville, KY 40223-2907 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2005 |
Last Update Date | 13/09/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
64255730 | (05) | KY |
C68146 | (02) | KY |