Provider Demographics
NPI:1902062268
Name:HESS, AMANDA R (DO)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:R
Last Name:HESS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:AMANDA
Other - Middle Name:SUISAN
Other - Last Name:ROBERTSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 1080
Mailing Address - Street 2:
Mailing Address - City:BURKESVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42717-1080
Mailing Address - Country:US
Mailing Address - Phone:270-858-6655
Mailing Address - Fax:270-858-4607
Practice Address - Street 1:279 KINGS DAUGHTERS DR
Practice Address - Street 2:SUITE 301
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-6561
Practice Address - Country:US
Practice Address - Phone:502-227-2229
Practice Address - Fax:502-227-1114
Is Sole Proprietor?:No
Enumeration Date:2008-08-05
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY03331207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100135540Medicaid
12138419OtherCAQH