Provider Demographics
NPI:1629355334
Name:AUBREY, AMANDA G (NP-C)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:G
Last Name:AUBREY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 950293
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0293
Mailing Address - Country:US
Mailing Address - Phone:888-987-1785
Mailing Address - Fax:405-609-1491
Practice Address - Street 1:3707 CHARLESTOWN RD STE C1
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-9254
Practice Address - Country:US
Practice Address - Phone:812-944-4575
Practice Address - Fax:812-944-4886
Is Sole Proprietor?:No
Enumeration Date:2011-11-09
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71003781A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner