Provider Demographics
NPI:1962580985
Name:YORK, AMY M (PA)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:M
Last Name:YORK
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MISS
Other - First Name:AMY
Other - Middle Name:LAUREN
Other - Last Name:MCMINN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:2 INNOVATION DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-5261
Mailing Address - Country:US
Mailing Address - Phone:864-235-7665
Mailing Address - Fax:864-233-5971
Practice Address - Street 1:2 INNOVATION DR
Practice Address - Street 2:SUITE 400
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-5261
Practice Address - Country:US
Practice Address - Phone:864-235-7665
Practice Address - Fax:864-233-5971
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1152363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP0975Medicaid
SCAA1681Medicare UPIN
SCGP0975Medicaid
SC4695Medicare PIN