Provider Demographics
NPI:1720288228
Name:HENDRIX, AMY N (DO)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:N
Last Name:HENDRIX
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 JACKSON PIKE
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-1560
Mailing Address - Country:US
Mailing Address - Phone:740-446-5381
Mailing Address - Fax:740-446-5082
Practice Address - Street 1:100 JACKSON PIKE
Practice Address - Street 2:
Practice Address - City:GALLIPOLIS
Practice Address - State:OH
Practice Address - Zip Code:45631-1560
Practice Address - Country:US
Practice Address - Phone:855-446-5937
Practice Address - Fax:740-446-5082
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2384207V00000X
OH34.010204207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV10122071Medicaid
OH000000432605OtherOHIO MEDICAID UNISON
OH0050884Medicaid
OH0050884OtherOHIO MEDICAID MOLINA
OH310917085257OtherOHIO MEDICAID CARESOURCE
OH0050884OtherOHIO MEDICAID MOLINA