Provider Demographics
NPI:1386616464
Name:COMER, AMY (ARNP)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:
Last Name:COMER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:452 E 4TH STREET
Mailing Address - Street 2:
Mailing Address - City:TOMPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42167
Mailing Address - Country:US
Mailing Address - Phone:270-487-6782
Mailing Address - Fax:270-487-5457
Practice Address - Street 1:452 E 4TH STREET
Practice Address - Street 2:
Practice Address - City:TOMPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42167
Practice Address - Country:US
Practice Address - Phone:270-487-6782
Practice Address - Fax:270-487-5457
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4666P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q77650Medicare UPIN
0273902Medicare PIN