Healthcare Provider Details

I. General information

NPI: 1295401024
Provider Name (Legal Business Name): ELIZABETH AMBURGEY ADKINS PH. D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2021
Last Update Date: 12/10/2021
Certification Date: 12/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12340 MAIN ST
JEFFERSONVILLE KY
40337-9619
US

IV. Provider business mailing address

12340 MAIN ST
JEFFERSONVILLE KY
40337-9619
US

V. Phone/Fax

Practice location:
  • Phone: 859-585-5891
  • Fax:
Mailing address:
  • Phone: 859-585-5891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: