Provider Demographics
NPI:1760708671
Name:STOCKTON, AMY (BSW, BHS)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:STOCKTON
Suffix:
Gender:F
Credentials:BSW, BHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 W UNION ST
Mailing Address - Street 2:
Mailing Address - City:MUNFORDVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42765-8911
Mailing Address - Country:US
Mailing Address - Phone:270-524-9883
Mailing Address - Fax:
Practice Address - Street 1:118 W UNION ST
Practice Address - Street 2:
Practice Address - City:MUNFORDVILLE
Practice Address - State:KY
Practice Address - Zip Code:42765-8911
Practice Address - Country:US
Practice Address - Phone:270-524-9883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-16
Last Update Date:2010-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY30604011Medicaid