Provider Demographics
NPI:1538177688
Name:RATLEY, AMY JO (DO)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:JO
Last Name:RATLEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1876 BETHEL CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:MORGANFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42437-6500
Mailing Address - Country:US
Mailing Address - Phone:270-333-6088
Mailing Address - Fax:
Practice Address - Street 1:520 W GUM ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:KY
Practice Address - Zip Code:42064-1516
Practice Address - Country:US
Practice Address - Phone:270-965-5238
Practice Address - Fax:270-965-9015
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY02657207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000551164OtherANTHEM BLUE CROSS BLUE SHIELD
KY64000441Medicaid
127611Medicare PIN
H66388Medicare UPIN