Provider Demographics
NPI:1912544545
Name:TOMPKINS, AMY ELIZABETH (APRN)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:ELIZABETH
Last Name:TOMPKINS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:ELIZABETH
Other - Last Name:LATHEM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:700 CHILDRENS DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43205-2664
Mailing Address - Country:US
Mailing Address - Phone:614-355-5823
Mailing Address - Fax:
Practice Address - Street 1:800 ROSE ST STE C114D
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-2664
Practice Address - Country:US
Practice Address - Phone:859-257-7618
Practice Address - Fax:859-257-4060
Is Sole Proprietor?:No
Enumeration Date:2019-12-02
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCNP.024034363LF0000X
OHAPRN.CNP.024034363LP0200X
KY4016492363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0384248Medicaid