Provider Demographics
NPI:1275978207
Name:ESTEP, AMANDA GRACE (MD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:GRACE
Last Name:ESTEP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:E
Other - Last Name:LANE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1138 LEXINGTON RD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-9672
Mailing Address - Country:US
Mailing Address - Phone:502-867-0222
Mailing Address - Fax:502-867-0420
Practice Address - Street 1:1138 LEXINGTON RD
Practice Address - Street 2:SUITE 130
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-9672
Practice Address - Country:US
Practice Address - Phone:502-867-0222
Practice Address - Fax:502-867-0420
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-03
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY01234207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program