Healthcare Provider Details

I. General information

NPI: 1871515718
Provider Name (Legal Business Name): AMY JACQUELINE TRIVETTE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 W HIGHWAY 146
LA GRANGE KY
40032-0001
US

IV. Provider business mailing address

6602 LOOKOVER CIR
CRESTWOOD KY
40014-9050
US

V. Phone/Fax

Practice location:
  • Phone: 502-222-9441
  • Fax:
Mailing address:
  • Phone: 502-724-5941
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License Number200200819
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number200200819
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number41105
License Number StateKY
# 4
Primary TaxonomyY
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License Number41105
License Number StateKY
# 5
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number01066299A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: