Provider Demographics
NPI:1013584754
Name:KEOWN, AMY M
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:M
Last Name:KEOWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1051 NORMANDY RD
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40071-9774
Mailing Address - Country:US
Mailing Address - Phone:502-491-4692
Mailing Address - Fax:502-491-4693
Practice Address - Street 1:2200 STONY BROOK DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-4014
Practice Address - Country:US
Practice Address - Phone:502-491-4692
Practice Address - Fax:502-491-4693
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-10
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1096816163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty