Healthcare Provider Details

I. General information

NPI: 1073272803
Provider Name (Legal Business Name): AMBER MICHELLE LODEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2021
Last Update Date: 12/09/2021
Certification Date: 12/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

737B NORTH DR
HOPKINSVILLE KY
42240-2620
US

IV. Provider business mailing address

PO BOX 614
HOPKINSVILLE KY
42241-0614
US

V. Phone/Fax

Practice location:
  • Phone: 270-890-1780
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: