Healthcare Provider Details

I. General information

NPI: 1356372759
Provider Name (Legal Business Name): AMY ELIZABETH FARRELL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY ELIZABETH BURR MD

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 08/02/2024
Certification Date: 08/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 W JOHN ROWAN BLVD STE E
BARDSTOWN KY
40004-2636
US

IV. Provider business mailing address

PO BOX 780982
PHILADELPHIA PA
19178-0982
US

V. Phone/Fax

Practice location:
  • Phone: 502-894-9494
  • Fax: 502-894-9404
Mailing address:
  • Phone: 303-306-7783
  • Fax: 303-306-7753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMO2005039869
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberMO2005039869
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberMO2005039869
License Number StateMO
# 4
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number42828
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: