Provider Demographics
NPI:1780260547
Name:CRISP, AMANDA KAY (RT)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:KAY
Last Name:CRISP
Suffix:
Gender:F
Credentials:RT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3088 TUSCALOOSA LN
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40515-5458
Mailing Address - Country:US
Mailing Address - Phone:859-321-6386
Mailing Address - Fax:
Practice Address - Street 1:3088 TUSCALOOSA LN
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40515-5458
Practice Address - Country:US
Practice Address - Phone:859-321-6386
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-22
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY7640227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified