Provider Demographics
NPI:1306475173
Name:DAVIS, AMY DIANE (APRN-FNP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:DIANE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:APRN-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:588 LILY LN
Mailing Address - Street 2:
Mailing Address - City:HANSON
Mailing Address - State:KY
Mailing Address - Zip Code:42413-8500
Mailing Address - Country:US
Mailing Address - Phone:270-875-1831
Mailing Address - Fax:
Practice Address - Street 1:190 N HOPKINSVILLE ST
Practice Address - Street 2:
Practice Address - City:NORTONVILLE
Practice Address - State:KY
Practice Address - Zip Code:42442-9799
Practice Address - Country:US
Practice Address - Phone:270-676-6063
Practice Address - Fax:270-676-6064
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-03
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3014533363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily