Provider Demographics
NPI:1730528126
Name:BURTON, AMY J (ME)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:J
Last Name:BURTON
Suffix:
Gender:F
Credentials:ME
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 SWEETWATER LN
Mailing Address - Street 2:
Mailing Address - City:GRAYSON
Mailing Address - State:KY
Mailing Address - Zip Code:41143-1748
Mailing Address - Country:US
Mailing Address - Phone:606-923-2853
Mailing Address - Fax:
Practice Address - Street 1:280 SWEETWATER LN
Practice Address - Street 2:
Practice Address - City:GRAYSON
Practice Address - State:KY
Practice Address - Zip Code:41143-1748
Practice Address - Country:US
Practice Address - Phone:606-923-2853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-18
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYXXX-XX-9202172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker