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General NPI Number Information
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NPI Number | 1396452934
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Entity Type | Organization
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Legal Business Name | AMANDA HENDRICKS, APRN, PLLC
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Dates
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Enumeration Date | 11/02/2022
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Last Update Date | 05/03/2023
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Provider Practice Location Address
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Address Line | 1230 WOODLAND DR STE 211
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City | ELIZABETHTOWN
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State | KY
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Zip | 42701-2792
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Country | US
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Telephone | 270-982-2500
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Fax | 270-982-2501
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Provider Business Mailing Address
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Address Line | 1230 WOODLAND DR STE 211
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City | ELIZABETHTOWN
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State | KY
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Zip | 42701-2792
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Country | US
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Telephone | 270-982-2500
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Fax | 270-982-2501
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Authorized Official
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Title or Position | OWNER
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Name | MRS. AMANDA SUE HENDRICKS
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Credential | APRN
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Telephone | 270-307-3905
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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