Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 36957 | KY |
N | 2080P0204X | Pediatric Emergency Doctor | 35.132313 | OH |
Y | 2080P0204X | Pediatric Emergency Doctor | 36957 | KY |
NPI | 1053395467 |
---|---|
Provider Name | Amanda Beth Myers |
First Address | Louisville, KY 40201-2469 |
Second Address | Louisville, KY 40202-1821 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2005 |
Last Update Date | 19/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0242682 | (05) | OH |
200360000 | (05) | IN |
64044803 | (05) | KY |
H53670 | (02) |