Healthcare Provider Details

I. General information

NPI: 1104735018
Provider Name (Legal Business Name): PURE AESTHETICS AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 W WHITE OAK ST STE C
LEITCHFIELD KY
42754-1070
US

IV. Provider business mailing address

302 W WHITE OAK ST STE C
LEITCHFIELD KY
42754-1070
US

V. Phone/Fax

Practice location:
  • Phone: 270-899-9861
  • Fax:
Mailing address:
  • Phone: 270-899-9861
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: AMY BOUNDS
Title or Position: OWNER
Credential: APRN
Phone: 731-377-6382