Provider Demographics
NPI:1104373307
Name:HAMILTON, AMANDA (ARNP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2119 CLARK DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-3217
Mailing Address - Country:US
Mailing Address - Phone:859-913-1708
Mailing Address - Fax:859-966-2594
Practice Address - Street 1:2119 CLARK DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-3217
Practice Address - Country:US
Practice Address - Phone:859-913-1708
Practice Address - Fax:859-966-2594
Is Sole Proprietor?:No
Enumeration Date:2016-09-06
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3010411363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily