Provider Demographics
NPI:1003837352
Name:FATHMAN, AMY E (CFNP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:E
Last Name:FATHMAN
Suffix:
Gender:F
Credentials:CFNP
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:45263-2498
Mailing Address - Country:US
Mailing Address - Phone:859-578-5241
Mailing Address - Fax:859-442-0046
Practice Address - Street 1:1400 GRAND AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:KY
Practice Address - Zip Code:41071-2570
Practice Address - Country:US
Practice Address - Phone:859-578-5241
Practice Address - Fax:859-442-0046
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3003600363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHNP22162Medicare PIN
OHNP22164Medicare PIN
OHNP22161Medicare PIN
OHNP22163Medicare PIN
OHP39149Medicare UPIN