Provider Demographics
NPI:1609288752
Name:KOON, AMBER N (DO)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:N
Last Name:KOON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:NICOLE
Other - Last Name:PELZL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1413 N ELM ST STE 204
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:KY
Mailing Address - Zip Code:42420-2773
Mailing Address - Country:US
Mailing Address - Phone:270-830-9973
Mailing Address - Fax:070-830-9975
Practice Address - Street 1:1413 N ELM ST STE 204
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:KY
Practice Address - Zip Code:42420-2773
Practice Address - Country:US
Practice Address - Phone:270-830-9973
Practice Address - Fax:270-830-9975
Is Sole Proprietor?:No
Enumeration Date:2014-05-23
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY04621208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery