Provider Demographics
NPI:1518158286
Name:OWEN, AMANDA R (ARNP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:R
Last Name:OWEN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:R
Other - Last Name:LANCASTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:PO BOX 776879
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6879
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5339
Practice Address - Street 1:1301 RING RD
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-8968
Practice Address - Country:US
Practice Address - Phone:270-765-2107
Practice Address - Fax:270-769-9642
Is Sole Proprietor?:No
Enumeration Date:2007-08-07
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3005248363L00000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY50016143OtherPASSPORT - CMA
KY1567385OtherFIRST HEALTH - CMA
KY000000534238OtherANTHEM - CMA
KY2861862000OtherPASSPORT ADVTG - CMA
KY7100014560Medicaid
KY000023028WOtherHUMANA - CMA
IN300056675Medicaid
KYK132010OtherMEDICARE
KY093346OtherSIHO - CMA