Provider Demographics
NPI:1245914068
Name:TYE, AMY M (MSN, PMHNP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:M
Last Name:TYE
Suffix:
Gender:F
Credentials:MSN, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1255 PROVIDENCE PLACE PKWY STE 115
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40511-8379
Mailing Address - Country:US
Mailing Address - Phone:859-486-2808
Mailing Address - Fax:859-441-1825
Practice Address - Street 1:1255 PROVIDENCE PLACE PKWY STE 115
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40511-8379
Practice Address - Country:US
Practice Address - Phone:859-486-2808
Practice Address - Fax:859-441-1825
Is Sole Proprietor?:No
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1138770363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health