Provider Demographics
NPI:1154967560
Name:COOLEY, AMANDA MAE (APRN)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:MAE
Last Name:COOLEY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 CHAMBERLAIN DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40517-1601
Mailing Address - Country:US
Mailing Address - Phone:859-699-0076
Mailing Address - Fax:
Practice Address - Street 1:1591 HUSTONVILLE RD
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422-2425
Practice Address - Country:US
Practice Address - Phone:859-724-3057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-20
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3013495363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily