Provider Demographics
NPI:1346071800
Name:FAYNE, AMBER LYNN (CNA,CPT)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:LYNN
Last Name:FAYNE
Suffix:
Gender:F
Credentials:CNA,CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 MIDLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40065-7791
Mailing Address - Country:US
Mailing Address - Phone:502-647-0154
Mailing Address - Fax:502-633-4043
Practice Address - Street 1:213 MIDLAND BLVD
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:KY
Practice Address - Zip Code:40065-7791
Practice Address - Country:US
Practice Address - Phone:502-647-0154
Practice Address - Fax:502-633-4043
Is Sole Proprietor?:No
Enumeration Date:2024-08-08
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY50104241376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide