Provider Demographics
NPI:1508995184
Name:GIBSON, AMY NIXON (MS ED)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:NIXON
Last Name:GIBSON
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 LAFAYETTE PKWY
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-1242
Mailing Address - Country:US
Mailing Address - Phone:859-277-7803
Mailing Address - Fax:
Practice Address - Street 1:295 LAFAYETTE PKWY
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-1242
Practice Address - Country:US
Practice Address - Phone:859-277-7803
Practice Address - Fax:000-000-0000
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYFS-01559171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYFS-01559OtherFIRST STEPS PROVIDER ID