Provider Demographics
NPI:1235379074
Name:HENDRICKSON, AMELIA ELIZABETH (APRN-FNP-BC, WHNP-BC)
Entity type:Individual
Prefix:
First Name:AMELIA
Middle Name:ELIZABETH
Last Name:HENDRICKSON
Suffix:
Gender:F
Credentials:APRN-FNP-BC, WHNP-BC
Other - Prefix:
Other - First Name:AMELIA
Other - Middle Name:ELIZABETH
Other - Last Name:GOINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:101 PROSPEROUS PL STE 350
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-1891
Mailing Address - Country:US
Mailing Address - Phone:859-654-0160
Mailing Address - Fax:859-712-9273
Practice Address - Street 1:101 PROSPEROUS PL STE 350
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1891
Practice Address - Country:US
Practice Address - Phone:859-654-0160
Practice Address - Fax:859-712-9273
Is Sole Proprietor?:No
Enumeration Date:2009-03-05
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3005965363LW0102X, 363L00000X
KY5965P363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100066600Medicaid
KY7100066600Medicaid
KY0912263Medicare PIN
KYK006941Medicare PIN
KY00818003Medicare PIN