Provider Demographics
NPI:1659333110
Name:HANEY, AMY SMITH (MD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:SMITH
Last Name:HANEY
Suffix:
Gender:F
Credentials:MD
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 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-442-6600
Mailing Address - Fax:859-442-6601
Practice Address - Street 1:2093 MEDICAL ARTS DR
Practice Address - Street 2:1ST FLOOR
Practice Address - City:HEBRON
Practice Address - State:KY
Practice Address - Zip Code:41048-9315
Practice Address - Country:US
Practice Address - Phone:859-442-6600
Practice Address - Fax:859-442-6601
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY28915207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200407710Medicaid
OH2401298Medicaid
KY64289150Medicaid
IN200407710Medicaid
KY0364934Medicare PIN
OH2401298Medicaid
KY64289150Medicaid