Provider Demographics
NPI:1659416493
Name:HENRY, AMY S (DO)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:S
Last Name:HENRY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2000 N ELM ST
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:HENDERSON
Mailing Address - State:KY
Mailing Address - Zip Code:42420-2385
Mailing Address - Country:US
Mailing Address - Phone:270-844-8144
Mailing Address - Fax:270-844-8145
Practice Address - Street 1:2000 N ELM ST
Practice Address - Street 2:SUITE 1A
Practice Address - City:HENDERSON
Practice Address - State:KY
Practice Address - Zip Code:42420-2385
Practice Address - Country:US
Practice Address - Phone:270-844-8144
Practice Address - Fax:270-844-8145
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN11012827207Q00000X
KY03103207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
U80035Medicare UPIN