Basic Information
| Provider Information | |||||||||
| NPI: | 1568862951 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KNEES | ||||||||
| FirstName: | AMY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2605 KENTUCKY AVE | ||||||||
| Address2: | SUITE 306 | ||||||||
| City: | PADUCAH | ||||||||
| State: | KY | ||||||||
| PostalCode: | 420033800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2704157653 | ||||||||
| FaxNumber: | 2705758359 | ||||||||
| Practice Location | |||||||||
| Address1: | 2603 KENTUCKY AVE | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | PADUCAH | ||||||||
| State: | KY | ||||||||
| PostalCode: | 420033814 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2705753113 | ||||||||
| FaxNumber: | 2705753588 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/04/2014 | ||||||||
| LastUpdateDate: | 12/07/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/07/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 3008813 | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 7100323360 | 05 | KY | MEDICAID |