Healthcare Provider Details

I. General information

NPI: 1073697546
Provider Name (Legal Business Name): AMY GOODWIN BAIRD ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY GOODWIN APRN

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 01/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6400 DUTCHMANS PKWY STE 345
LOUISVILLE KY
40205
US

IV. Provider business mailing address

100 E LIBERTY ST STE 800
LOUISVILLE KY
40202-1428
US

V. Phone/Fax

Practice location:
  • Phone: 502-587-6010
  • Fax: 502-587-1314
Mailing address:
  • Phone: 502-587-6010
  • Fax: 502-587-1314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number4138P
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3004138
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: