Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 3015173 | KY |
NPI | 1003402496 |
---|---|
Provider Name | Amanda Jones |
First Address | Louisville, KY 40258-1140 |
Second Address | Louisville, KY 40258-1140 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2020 |
Last Update Date | 19/12/2020 |