Provider Demographics
NPI:1780878330
Name:CARRILLO, AMY D (DO)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:D
Last Name:CARRILLO
Suffix:
Gender:F
Credentials:DO
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:606-330-7840
Mailing Address - Fax:606-330-7825
Practice Address - Street 1:170 N EAGLE CREEK DR STE 104
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-9087
Practice Address - Country:US
Practice Address - Phone:859-967-5848
Practice Address - Fax:859-967-5473
Is Sole Proprietor?:No
Enumeration Date:2007-08-28
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDO0000001939207V00000X
KY03678207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN41954515OtherBLUE CROSS BLUE SHIELD OF TN
KY7100314440 (KOHMG)Medicaid
KY7100314440Medicaid
TN1508408Medicaid