Provider Demographics
NPI:1285668244
Name:RICH, AMY R (PA-C)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:R
Last Name:RICH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2268
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28603-2268
Mailing Address - Country:US
Mailing Address - Phone:828-855-1192
Mailing Address - Fax:828-358-0832
Practice Address - Street 1:116 3RD ST NW STE 102
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-6137
Practice Address - Country:US
Practice Address - Phone:828-855-1192
Practice Address - Fax:828-358-0832
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC00101434363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC970016955OtherRR MEDICARE
NC970016955OtherRR MEDICARE
NC2743043Medicare PIN
NCS33242Medicare UPIN