Lexington Medical Tattooing

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

LEXINGTON MEDICAL TATTOOING

Practice address

166 Prosperous PL Ste 300
Lexington, KY 40509-2178

Phone

(859) 550-6224

NPI assigned

Feb 13, 2025

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Carissa Fondaw

Title

Owner

Phone

(859) 550-6224

Specialties & licenses 1

Addresses

Other names 1

• Lexington Medical Tattooing & Scar Correction Other name

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1739404800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1739404800000",
    "number": "1750186938",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "166 PROSPEROUS PL STE 300",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405092178",
            "telephone_number": "859-550-6224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "166 PROSPEROUS PL STE 300",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405092178",
            "telephone_number": "859-550-6224"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEXINGTON MEDICAL TATTOOING",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-02-13",
        "last_updated": "2025-02-13",
        "certification_date": "2025-02-13",
        "status": "A",
        "authorized_official_last_name": "FONDAW",
        "authorized_official_first_name": "CARISSA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "859-550-6224"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lexington Medical Tattooing & Scar Correction",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Specialist in Lexington, KY
• Providers in Lexington, KY by specialty
• Specialist in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.