1790018513 NPI number — AMY L. DOOLITTLE-CRIDER ARNP

Table of content: AMY L. DOOLITTLE-CRIDER ARNP (NPI 1790018513)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790018513 NPI number — AMY L. DOOLITTLE-CRIDER ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOOLITTLE-CRIDER
Provider First Name:
AMY
Provider Middle Name:
L.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790018513
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/28/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8 CADILLAC DR
Provider Second Line Business Mailing Address:
STE. 250
Provider Business Mailing Address City Name:
BRENTWOOD
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37027-5087
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-425-4200
Provider Business Mailing Address Fax Number:
615-425-4271

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2360 STONY BROOK DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40220-4018
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-446-5462
Provider Business Practice Location Address Fax Number:
502-394-3670
Provider Enumeration Date:
09/11/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  6114P , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)