Healthcare Provider Details

I. General information

NPI: 1255062915
Provider Name (Legal Business Name): MARY AMELIA OXFORD APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2022
Last Update Date: 09/26/2025
Certification Date: 09/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 HIGH ST
HOPKINSVILLE KY
42240-6300
US

IV. Provider business mailing address

408 42ND AVE N STE 300
NASHVILLE TN
37209-3669
US

V. Phone/Fax

Practice location:
  • Phone: 270-874-2107
  • Fax:
Mailing address:
  • Phone: 615-356-4111
  • Fax: 615-356-8011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3017972
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: