Healthcare Provider Details

I. General information

NPI: 1780260547
Provider Name (Legal Business Name): AMANDA KAY CRISP RT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2021
Last Update Date: 03/22/2021
Certification Date: 03/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3088 TUSCALOOSA LN
LEXINGTON KY
40515-5458
US

IV. Provider business mailing address

3088 TUSCALOOSA LN
LEXINGTON KY
40515-5458
US

V. Phone/Fax

Practice location:
  • Phone: 859-321-6386
  • Fax:
Mailing address:
  • Phone: 859-321-6386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License Number7640
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: