Healthcare Provider Details

I. General information

NPI: 1073399812
Provider Name (Legal Business Name): AMANDA METCALFE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA HORN

II. Dates (important events)

Enumeration Date: 09/07/2023
Last Update Date: 09/07/2023
Certification Date: 09/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 BISHOP LN
ELIZABETHTOWN KY
42701-9266
US

IV. Provider business mailing address

503 GREENCREST DR
CECILIA KY
42724-9690
US

V. Phone/Fax

Practice location:
  • Phone: 270-234-0003
  • Fax: 270-360-0840
Mailing address:
  • Phone: 502-417-9675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: