Healthcare Provider Details

I. General information

NPI: 1205227071
Provider Name (Legal Business Name): AMY ELIZABETH THOMAS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2015
Last Update Date: 03/28/2025
Certification Date: 03/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 TOWNE DR
ELIZABETHTOWN KY
42701-8460
US

IV. Provider business mailing address

PO BOX 932958
CLEVELAND OH
44193-0028
US

V. Phone/Fax

Practice location:
  • Phone: 270-765-3488
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3009258
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: