Provider Demographics
NPI:1629352059
Name:ADKISSON, AMY L (PA-C)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:L
Last Name:ADKISSON
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:2600 STANLEY GAULT PKWY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-4197
Mailing Address - Country:US
Mailing Address - Phone:502-238-2801
Mailing Address - Fax:502-238-2835
Practice Address - Street 1:1023 SANIBEL WAY
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:KY
Practice Address - Zip Code:40031-9157
Practice Address - Country:US
Practice Address - Phone:502-222-3302
Practice Address - Fax:502-222-3624
Is Sole Proprietor?:No
Enumeration Date:2011-10-04
Last Update Date:2016-10-28
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Provider Licenses
StateLicense IDTaxonomies
KYPA1596363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant