Provider Demographics
NPI:1184675217
Name:NALLEY, AMY (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:
Last Name:NALLEY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MISS
Other - First Name:AMY
Other - Middle Name:RENEE
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:401 E CHESTNUT ST
Mailing Address - Street 2:STE 102
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-5700
Mailing Address - Country:US
Mailing Address - Phone:502-588-4271
Mailing Address - Fax:502-588-4280
Practice Address - Street 1:401 E CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1622
Practice Address - Country:US
Practice Address - Phone:502-588-4271
Practice Address - Fax:502-588-4280
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3003856363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200510750Medicaid
KY78013752Medicaid
IN200510750Medicaid
KY0048456Medicare PIN
KY0631275Medicare PIN