Provider Demographics
NPI:1245124437
Name:DOCIMO, AMBER (APRN, CPNP-PC)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:DOCIMO
Suffix:
Gender:F
Credentials:APRN, CPNP-PC
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:
Other - Last Name:HAWK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1347 US HIGHWAY 60 W
Mailing Address - Street 2:
Mailing Address - City:LEDBETTER
Mailing Address - State:KY
Mailing Address - Zip Code:42058-9554
Mailing Address - Country:US
Mailing Address - Phone:270-485-4316
Mailing Address - Fax:
Practice Address - Street 1:615 7TH AVE
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-6921
Practice Address - Country:US
Practice Address - Phone:270-846-4800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-04
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4029691363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Multi-Specialty