Provider Demographics
NPI:1861759128
Name:HIMES, AMY KATHERINE (LPN)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:KATHERINE
Last Name:HIMES
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:AMY
Other - Middle Name:KATHERINE
Other - Last Name:HIMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:429 DRY BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MEXICO
Mailing Address - State:NY
Mailing Address - Zip Code:13114-3332
Mailing Address - Country:US
Mailing Address - Phone:315-298-6332
Mailing Address - Fax:
Practice Address - Street 1:429 DRY BRIDGE RD
Practice Address - Street 2:
Practice Address - City:MEXICO
Practice Address - State:NY
Practice Address - Zip Code:13114-3332
Practice Address - Country:US
Practice Address - Phone:315-298-6332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-11
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY181799-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse