Provider Demographics
NPI:1609848803
Name:HILL, AMY J (PAC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:J
Last Name:HILL
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:J
Other - Last Name:TILLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:911 FLAT ROCK RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40245-4313
Mailing Address - Country:US
Mailing Address - Phone:502-883-2218
Mailing Address - Fax:502-883-2031
Practice Address - Street 1:12400 SHELBYVILLE RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:KY
Practice Address - Zip Code:40243-1419
Practice Address - Country:US
Practice Address - Phone:502-883-2218
Practice Address - Fax:502-883-2031
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA867363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY95004958Medicaid
KYK050613OtherMEDICARE
KYP00262355OtherRRMCA NUMBER
KYP00262355OtherRRMCA NUMBER