Provider Demographics
NPI:1972747848
Name:AVERY, AMY TAYLOR (CRNP)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:TAYLOR
Last Name:AVERY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:AMY TAYLOR
Other - Middle Name:
Other - Last Name:WILLITS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:909 RIDGEBROOK RD STE 300
Mailing Address - Street 2:
Mailing Address - City:SPARKS GLENCOE
Mailing Address - State:MD
Mailing Address - Zip Code:21152-9477
Mailing Address - Country:US
Mailing Address - Phone:443-383-9300
Mailing Address - Fax:717-249-9332
Practice Address - Street 1:905 TOWER RD STE 3188
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:PA
Practice Address - Zip Code:19007-3116
Practice Address - Country:US
Practice Address - Phone:443-383-9300
Practice Address - Fax:855-866-8710
Is Sole Proprietor?:No
Enumeration Date:2009-04-23
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN542564163W00000X
PASP007702363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse