| Doctor Name: | AMY LYNN FOWKES |
| NPI Number: | 1083965206 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PSYD |
| License Number: | 2011-100 |
| Business Practice Address: | 6200 Crestwood Sta Suite A Crestwood, KY - 400147418 |
| Business Phone Number: | 5022432622 |
| Business Fax Number: | 5022432692 |
| Mailing Address: | 10408 Shadow Ridge Ln, LOUISVILLE |
| State: | KY |
| Postal Code: | 402411299 |
| Phone Number: | 4127704181 |
| Fax Number: | |
| NPI Enumeration Date: | 09/27/2012 |
| NPI Last Update Date: | 09/27/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC1900X |
| License Number: | 2011-100 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | KY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Counseling |
| Taxonomy Definition: | |