Provider Demographics
NPI:1932308855
Name:PHILLIPS, AMANDA CALLOWAY (NP)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:CALLOWAY
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:NP
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 950244
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0244
Mailing Address - Country:US
Mailing Address - Phone:502-953-4700
Mailing Address - Fax:502-774-8631
Practice Address - Street 1:1000 NEIGHBORHOOD PL
Practice Address - Street 2:
Practice Address - City:FAIRDALE
Practice Address - State:KY
Practice Address - Zip Code:40118-9697
Practice Address - Country:US
Practice Address - Phone:502-361-2381
Practice Address - Fax:502-363-1463
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28146751A163W00000X
IN71001599A363LW0102X
KY1093115363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100068450Medicaid