Provider Demographics
NPI:1225461643
Name:KILBURN, AMY L (CNP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:L
Last Name:KILBURN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:L
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1735 27TH ST STE B06
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-2681
Mailing Address - Country:US
Mailing Address - Phone:740-356-8034
Mailing Address - Fax:740-353-7900
Practice Address - Street 1:1611 27TH ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-6931
Practice Address - Country:US
Practice Address - Phone:740-356-6836
Practice Address - Fax:740-356-6803
Is Sole Proprietor?:No
Enumeration Date:2013-08-21
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.15059-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0089747Medicaid
KY7100341110Medicaid