Healthcare Provider Details

I. General information

NPI: 1386336006
Provider Name (Legal Business Name): DR. AMANDA O'BRYAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2023
Last Update Date: 05/22/2023
Certification Date: 05/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1028 BARRET AVE
LOUISVILLE KY
40204-1667
US

IV. Provider business mailing address

1327 HIGHLAND AVE APT 2
LOUISVILLE KY
40204-2552
US

V. Phone/Fax

Practice location:
  • Phone: 502-451-1221
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: