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General NPI Number Information
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NPI Number | 1639650831
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Entity Type | Individual
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Provider Name | AMANDA DAWN JARVIS APRN
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Gender | Female
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Dates
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Enumeration Date | 08/24/2018
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Last Update Date | 06/30/2025
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Provider Practice Location Address
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Address Line | 1354 BULL LEA RD
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City | LEXINGTON
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State | KY
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Zip | 40511-1247
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Country | US
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Telephone | 859-562-3899
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Fax | 859-257-6200
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Provider Business Mailing Address
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Address Line | 804 MOHEGAN TRL
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City | GEORGETOWN
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State | KY
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Zip | 40324-1016
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Country | US
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Telephone | 859-608-9270
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 3012582
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License Number State | KY
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