Provider Demographics
NPI:1316783533
Name:GRACE, AMYA (LPN)
Entity type:Individual
Prefix:
First Name:AMYA
Middle Name:
Last Name:GRACE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 AXIS DR APT 205
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-0079
Mailing Address - Country:US
Mailing Address - Phone:502-579-4106
Mailing Address - Fax:
Practice Address - Street 1:300 AXIS DR APT 205
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40206-0079
Practice Address - Country:US
Practice Address - Phone:502-579-4106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN64153164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse