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NPI Code Detail

MEDICARE: AMY NICOLE HEAD APRN

MEDICARE: AMY NICOLE HEAD APRN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner3007454KY

General Provider Information

NPI Number : 1386990356
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMY NICOLE HEAD APRN
Provider Business Mailing Address
First Line : 5200 COMMERCE CROSSINGS DR FL 3
Second Line :
City : LOUISVILLE
State : KY
Zip : 40229-2182
Country : US
Telephone Number : 502-253-4924
Fax Number : 502-489-5750
Provider Business Practice Location Address
First Line : 6580 KENWOOD CROSSING RD
Second Line :
City : CRESTWOOD
State : KY
Zip : 40014-7614
Country : US
Telephone Number : 502-243-3161
Fax Number : 502-243-3164
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/27/2012
Last Update Date : 12/09/2020

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