Provider Demographics
NPI:1588232490
Name:WALDRIDGE, AMY
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:WALDRIDGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4619 CLARK STATION RD
Mailing Address - Street 2:
Mailing Address - City:FINCHVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40022-5758
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4247 WESTPORT RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-2227
Practice Address - Country:US
Practice Address - Phone:502-893-3033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-16
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1126103163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse