Provider Demographics
NPI:1972170181
Name:PACK, LYDIA NICOLE (GC)
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:NICOLE
Last Name:PACK
Suffix:
Gender:F
Credentials:GC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 ROSE ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-7001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:800 ROSE ST WHITNEY HENDRICKSON BLDG STE 134
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-4322
Practice Address - Country:US
Practice Address - Phone:859-323-2650
Practice Address - Fax:859-323-0702
Is Sole Proprietor?:No
Enumeration Date:2021-06-07
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYGC563170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS