Healthcare Provider Details

I. General information

NPI: 1396999629
Provider Name (Legal Business Name): AMBER M GEARHART APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2008
Last Update Date: 03/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL VILLAGE DR
EDGEWOOD KY
41017-3403
US

IV. Provider business mailing address

2300 CHAMBER CENTER DR
FT. MITCHELL KY
41017-1673
US

V. Phone/Fax

Practice location:
  • Phone: 859-301-6160
  • Fax: 859-301-2650
Mailing address:
  • Phone: 859-301-2000
  • Fax: 859-426-4100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3010740
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number304910
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: