Provider Demographics
NPI:1235379074
Name:HENDRICKSON, AMELIA ELIZABETH (APRN-WHNP)
Entity Type:Individual
Prefix:
First Name:AMELIA
Middle Name:ELIZABETH
Last Name:HENDRICKSON
Suffix:
Gender:F
Credentials:APRN-WHNP
Other - Prefix:
Other - First Name:AMELIA
Other - Middle Name:ELIZABETH
Other - Last Name:GOINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:330 WALLER AVE
Mailing Address - Street 2:STE. 100
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-2931
Mailing Address - Country:US
Mailing Address - Phone:859-254-7000
Mailing Address - Fax:859-255-4381
Practice Address - Street 1:330 WALLER AVE
Practice Address - Street 2:STE. 100
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-2931
Practice Address - Country:US
Practice Address - Phone:859-254-7000
Practice Address - Fax:859-255-4381
Is Sole Proprietor?:No
Enumeration Date:2009-03-05
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5965P363LW0102X
KY3005965363LW0102X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100066600Medicaid
KY7100066600Medicaid
KY0912263Medicare PIN
KYK006941Medicare PIN
KY00818003Medicare PIN