Provider Demographics
NPI:1568857621
Name:FUTRELL, AMANDA AYDELETTE (PA-C)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:AYDELETTE
Last Name:FUTRELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:SUE
Other - Last Name:AYDELETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1983 SINGLETREE LN
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-7943
Mailing Address - Country:US
Mailing Address - Phone:252-801-6001
Mailing Address - Fax:
Practice Address - Street 1:919 JR HIGH SCHOOL RD
Practice Address - Street 2:
Practice Address - City:SCOTLAND NECK
Practice Address - State:NC
Practice Address - Zip Code:27874-1219
Practice Address - Country:US
Practice Address - Phone:252-826-3143
Practice Address - Fax:252-826-3110
Is Sole Proprietor?:No
Enumeration Date:2015-04-05
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-06648363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant