Provider Demographics
NPI:1073697546
Name:BAIRD, AMY GOODWIN (ARNP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:GOODWIN
Last Name:BAIRD
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:GOODWIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:100 E LIBERTY ST STE 800
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1428
Mailing Address - Country:US
Mailing Address - Phone:502-587-6010
Mailing Address - Fax:502-587-1314
Practice Address - Street 1:6400 DUTCHMANS PKWY STE 345
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205
Practice Address - Country:US
Practice Address - Phone:502-587-6010
Practice Address - Fax:502-587-1314
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4138P363LA2200X
KY3004138363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYK121191OtherKY MEDICARE
KYP01977554OtherRR MEDICARE
KY7100413330Medicaid