Provider Demographics
NPI:1710773825
Name:CARR, DONALD LEE (CST/CSFA, KCSA)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:LEE
Last Name:CARR
Suffix:
Gender:M
Credentials:CST/CSFA, KCSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:782 S DOGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BEREA
Mailing Address - State:KY
Mailing Address - Zip Code:40403-9563
Mailing Address - Country:US
Mailing Address - Phone:859-408-3152
Mailing Address - Fax:
Practice Address - Street 1:2376 ALEXANDRIA DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-3229
Practice Address - Country:US
Practice Address - Phone:859-296-3195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-16
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYSA439246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant