Basic Information
| Provider Information | |||||||||
| NPI: | 1255323184 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JONES | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | LANKFORD | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 353 BOGLE ST | ||||||||
| Address2: | SUITE C | ||||||||
| City: | SOMERSET | ||||||||
| State: | KY | ||||||||
| PostalCode: | 425032888 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6066782220 | ||||||||
| FaxNumber: | 6066782219 | ||||||||
| Practice Location | |||||||||
| Address1: | 353 BOGLE ST | ||||||||
| Address2: | SUITE C | ||||||||
| City: | SOMERSET | ||||||||
| State: | KY | ||||||||
| PostalCode: | 425032888 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6066782220 | ||||||||
| FaxNumber: | 6066782219 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2005 | ||||||||
| LastUpdateDate: | 12/04/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA679 | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 95001780 | 05 | KY | MEDICAID | 000000505007 | 01 | KY | BCBS INDIVIDUAL # | OTHER | 7100016460 | 01 | KY | KY MEDICAID GROUP # | OTHER | 00196 | 01 | MEDICARE GROUP PIN# | OTHER |