Provider Demographics
NPI:1992505374
Name:MAIN, AMI BETH
Entity type:Individual
Prefix:MRS
First Name:AMI
Middle Name:BETH
Last Name:MAIN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1385 RIDDLE AVE
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-2640
Mailing Address - Country:US
Mailing Address - Phone:304-276-1275
Mailing Address - Fax:304-276-1275
Practice Address - Street 1:1385 RIDDLE AVE
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-2640
Practice Address - Country:US
Practice Address - Phone:304-276-1275
Practice Address - Fax:304-276-1275
Is Sole Proprietor?:No
Enumeration Date:2025-03-15
Last Update Date:2025-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide