Healthcare Provider Details

I. General information

NPI: 1386990356
Provider Name (Legal Business Name): AMY NICOLE HEAD APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2012
Last Update Date: 12/09/2020
Certification Date: 12/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6580 KENWOOD CROSSING RD
CRESTWOOD KY
40014-7614
US

IV. Provider business mailing address

5200 COMMERCE CROSSINGS DR FL 3
LOUISVILLE KY
40229-2182
US

V. Phone/Fax

Practice location:
  • Phone: 502-243-3161
  • Fax: 502-243-3164
Mailing address:
  • Phone: 502-253-4924
  • Fax: 502-489-5750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3007454
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: