Individual
MRS. AMANDA CALLOWAY PHILLIPS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1000 NEIGHBORHOOD PL, FAIRDALE, KY 40118-9697
(502) 361-2381
(502) 363-1463
Mailing address
PO BOX 950244, LOUISVILLE, KY 40295-0244
(502) 953-4700
(502) 774-8631
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28146751A
IN
363LW0102X
Women's Health Nurse Practitioner
Primary
1093115
KY
363LW0102X
Women's Health Nurse Practitioner
71001599A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100068450
—
KY
Enumeration date
07/11/2007
Last updated
04/19/2021
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