Provider Demographics
NPI:1073093357
Name:ZACHEM, AMANDA (APRN)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:
Last Name:ZACHEM
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1780 NICHOLASVILLE RD.
Mailing Address - Street 2:SUITE #203
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503
Mailing Address - Country:US
Mailing Address - Phone:859-277-7949
Mailing Address - Fax:859-278-9279
Practice Address - Street 1:1780 NICHOLASVILLE RD.
Practice Address - Street 2:SUITE #203
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503
Practice Address - Country:US
Practice Address - Phone:859-277-7949
Practice Address - Fax:859-278-9279
Is Sole Proprietor?:No
Enumeration Date:2018-08-16
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3012553363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily