Provider Demographics
NPI:1871515718
Name:TRIVETTE, AMY JACQUELINE (MD)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:JACQUELINE
Last Name:TRIVETTE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:160 N BELLAIRE AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-2042
Mailing Address - Country:US
Mailing Address - Phone:502-721-0412
Mailing Address - Fax:502-721-0412
Practice Address - Street 1:1612 DAWKINS RD
Practice Address - Street 2:BOX 67
Practice Address - City:LA GRANGE
Practice Address - State:KY
Practice Address - Zip Code:40031-8729
Practice Address - Country:US
Practice Address - Phone:502-222-7161
Practice Address - Fax:502-222-7798
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-23
Last Update Date:2009-05-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC2002008192084F0202X, 2084P0800X
KY411052084P0800X, 2084F0202X
IN01066299A2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC947390Medicare UPIN