Healthcare Provider Details

I. General information

NPI: 1184726580
Provider Name (Legal Business Name): AMY D RAPP PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY D WYATT PA

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 01/11/2023
Certification Date: 01/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2065 E SOUTH BLVD SUITE 204
MONTGOMERY AL
36116-2458
US

IV. Provider business mailing address

2065 E SOUTH BLVD STE 204
MONTGOMERY AL
36116-2460
US

V. Phone/Fax

Practice location:
  • Phone: 334-281-6990
  • Fax: 334-281-9725
Mailing address:
  • Phone: 334-747-7300
  • Fax: 334-747-7320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA120
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: