Provider Demographics
NPI:1669479085
Name:HARWARD, AMY ELISABETH (PA)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:ELISABETH
Last Name:HARWARD
Suffix:
Gender:F
Credentials:PA
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 936
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40743-0936
Mailing Address - Country:US
Mailing Address - Phone:606-330-7818
Mailing Address - Fax:606-330-7825
Practice Address - Street 1:740 S LIMESTONE STE J107
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-3751
Practice Address - Country:US
Practice Address - Phone:859-323-5603
Practice Address - Fax:859-323-3704
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA269363AM0700X, 363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYCN8331OtherRAILROAD MEDICARE
KYCF7805OtherRAILROAD MEDICARE
KYCJ2601OtherRAILROAD MEDICARE
KY95004172Medicaid
KYCN8331OtherRAILROAD MEDICARE
KYR94007Medicare UPIN
KY95004172Medicaid