Provider Demographics
NPI:1598383861
Name:WIRES, AMBER DENISE (RN)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:DENISE
Last Name:WIRES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3504 CUMBERLAND AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLESBORO
Mailing Address - State:KY
Mailing Address - Zip Code:40965-2612
Mailing Address - Country:US
Mailing Address - Phone:606-248-0737
Mailing Address - Fax:
Practice Address - Street 1:3504 CUMBERLAND AVE
Practice Address - Street 2:
Practice Address - City:MIDDLESBORO
Practice Address - State:KY
Practice Address - Zip Code:40965-2612
Practice Address - Country:US
Practice Address - Phone:606-248-0737
Practice Address - Fax:606-248-0739
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-13
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001260036163W00000X
KY3015664363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse