Provider Demographics
NPI:1134825169
Name:MATHER, AMANDA NICOLE (APRN)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:NICOLE
Last Name:MATHER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 NICHOLASVILLE RD STE 304
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-2526
Mailing Address - Country:US
Mailing Address - Phone:859-277-5771
Mailing Address - Fax:859-275-4622
Practice Address - Street 1:2101 NICHOLASVILLE RD STE 304
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-2526
Practice Address - Country:US
Practice Address - Phone:859-277-5771
Practice Address - Fax:859-275-4622
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-01
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3018971363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily