Provider Demographics
NPI:1811458250
Name:WOOTEN, AMELIA ADELAIDE (MD)
Entity type:Individual
Prefix:
First Name:AMELIA
Middle Name:ADELAIDE
Last Name:WOOTEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 ROSE ST RM MN-118
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-7001
Mailing Address - Country:US
Mailing Address - Phone:859-323-5157
Mailing Address - Fax:859-323-1315
Practice Address - Street 1:2195 HARRODSBURG RD STE 2
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-3516
Practice Address - Country:US
Practice Address - Phone:859-562-1868
Practice Address - Fax:859-257-0421
Is Sole Proprietor?:No
Enumeration Date:2019-03-28
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY601582084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology