Healthcare Provider Details

I. General information

NPI: 1235904541
Provider Name (Legal Business Name): AMBER THOMPSON BA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2023
Last Update Date: 11/16/2023
Certification Date: 11/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 TOWNEPARK CIR
LOUISVILLE KY
40243-2338
US

IV. Provider business mailing address

12403 SOMERSET DR
LOUISVILLE KY
40229-3528
US

V. Phone/Fax

Practice location:
  • Phone: 502-432-8708
  • Fax:
Mailing address:
  • Phone: 502-432-8708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code405300000X
TaxonomyPrevention Professional
License Number00000000
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: