Basic Information
| Provider Information | |||||||||
| NPI: | 1962583948 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRITT | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | CRNA | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | CALLIS | ||||||||
| OtherFirstName: | AMY | ||||||||
| OtherMiddleName: | V | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | CRNA | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 256 SAINT ANTHONY RD | ||||||||
| Address2: | |||||||||
| City: | UTICA | ||||||||
| State: | KY | ||||||||
| PostalCode: | 423769730 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2706845005 | ||||||||
| FaxNumber: | 2709264432 | ||||||||
| Practice Location | |||||||||
| Address1: | 815 E PARRISH AVE | ||||||||
| Address2: | SUITE 460 | ||||||||
| City: | OWENSBORO | ||||||||
| State: | KY | ||||||||
| PostalCode: | 423033222 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2706845005 | ||||||||
| FaxNumber: | 2709264432 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2006 | ||||||||
| LastUpdateDate: | 02/23/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 1117A | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 367500000X | 28220785A | IN | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 74111717 | 05 | KY | MEDICAID |