Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 5011653 | NC |
N | 363L00000X | Nurse Practitioner | 5011654 | NC |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 5011653 | NC |
NPI | 1164985008 |
---|---|
Provider Name | Amy Louise Crittenden |
First Address | Mount Airy, NC 27030-5040 |
Second Address | Mount Airy, NC 27030-5039 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2019 |
Last Update Date | 18/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5011653 | NORTH CAROLINA BOARD OF NURSING (01) | NC |