Provider Demographics
NPI:1255323184
Name:JONES, AMY LANKFORD (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:LANKFORD
Last Name:JONES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:353 BOGLE ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503-2888
Mailing Address - Country:US
Mailing Address - Phone:606-678-2220
Mailing Address - Fax:606-678-2219
Practice Address - Street 1:353 BOGLE ST
Practice Address - Street 2:SUITE C
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-2888
Practice Address - Country:US
Practice Address - Phone:606-678-2220
Practice Address - Fax:606-678-2219
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA679363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY95001780Medicaid
KY000000505007OtherBCBS INDIVIDUAL #
KY7100016460OtherKY MEDICAID GROUP #
00196OtherMEDICARE GROUP PIN#
KY95001780Medicaid
00196OtherMEDICARE GROUP PIN#
P41867Medicare UPIN