Healthcare Provider Details

I. General information

NPI: 1356970669
Provider Name (Legal Business Name): AMANDA YBANEZ PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2020
Last Update Date: 07/11/2022
Certification Date: 07/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 S LIMESTONE STE L504
LEXINGTON KY
40536-1791
US

IV. Provider business mailing address

3306 ALCOTT PL
LEXINGTON KY
40509-7805
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-9555
  • Fax: 859-257-9288
Mailing address:
  • Phone: 304-638-8565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberTC977
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA2714
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA2714
License Number StateKY
# 4
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2714
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: