Provider Demographics
NPI:1083024210
Name:BLEVINS, AMARIS
Entity Type:Individual
Prefix:
First Name:AMARIS
Middle Name:
Last Name:BLEVINS
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 1:1351 NEWTOWN PIKE
Mailing Address - Street 2:BLDG 5
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40511-1275
Mailing Address - Country:US
Mailing Address - Phone:859-254-3106
Mailing Address - Fax:859-253-1177
Practice Address - Street 1:1351 NEWTOWN PIKE
Practice Address - Street 2:BLDG 5
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40511-1275
Practice Address - Country:US
Practice Address - Phone:859-254-3106
Practice Address - Fax:859-253-1177
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-28
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1790731081Medicaid