Healthcare Provider Details

I. General information

NPI: 1811458250
Provider Name (Legal Business Name): AMELIA ADELAIDE WOOTEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2019
Last Update Date: 12/23/2024
Certification Date: 12/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2195 HARRODSBURG RD STE 2
LEXINGTON KY
40504-3516
US

IV. Provider business mailing address

800 ROSE ST RM MN-118
LEXINGTON KY
40536-7001
US

V. Phone/Fax

Practice location:
  • Phone: 859-562-1868
  • Fax: 859-257-0421
Mailing address:
  • Phone: 859-323-5157
  • Fax: 859-323-1315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number60158
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: