Provider Demographics
NPI:1740098508
Name:POTEET-WOOLEN, AMANDA DALE (CPM)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:DALE
Last Name:POTEET-WOOLEN
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 S DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:MUNFORDVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42765-9268
Mailing Address - Country:US
Mailing Address - Phone:270-537-3881
Mailing Address - Fax:
Practice Address - Street 1:1325 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:MUNFORDVILLE
Practice Address - State:KY
Practice Address - Zip Code:42765-9268
Practice Address - Country:US
Practice Address - Phone:270-537-3881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-26
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYCPM24120630176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Multi-Specialty