Provider Demographics
NPI:1043644453
Name:KING, AMANDA BROOKE
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:BROOKE
Last Name:KING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 MILLHOUSE DR
Mailing Address - Street 2:
Mailing Address - City:NICHOLASVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40356-2423
Mailing Address - Country:US
Mailing Address - Phone:859-967-8664
Mailing Address - Fax:
Practice Address - Street 1:221 MILLHOUSE DR
Practice Address - Street 2:
Practice Address - City:NICHOLASVILLE
Practice Address - State:KY
Practice Address - Zip Code:40356-2423
Practice Address - Country:US
Practice Address - Phone:859-967-8664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-22
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula