Healthcare Provider Details

I. General information

NPI: 1427787571
Provider Name (Legal Business Name): AMANDA BAKER THOMAS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2022
Last Update Date: 04/07/2023
Certification Date: 10/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 S LIMESTONE
LEXINGTON KY
40536-7001
US

IV. Provider business mailing address

740 S LIMESTONE
LEXINGTON KY
40536-7001
US

V. Phone/Fax

Practice location:
  • Phone: 859-218-2522
  • Fax: 859-323-3918
Mailing address:
  • Phone: 593-235-6258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License Number3017877
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: