Healthcare Provider Details

I. General information

NPI: 1235540089
Provider Name (Legal Business Name): AMY LELA MARTIN NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2014
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 ROCKFORD ST
MOUNT AIRY NC
27030-5322
US

IV. Provider business mailing address

1248 UNITY CHURCH RD
CLAUDVILLE VA
24076-3540
US

V. Phone/Fax

Practice location:
  • Phone: 336-786-6068
  • Fax:
Mailing address:
  • Phone: 276-251-3203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024195555
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0024195555
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0024195555
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0024195555
License Number StateVA
# 5
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number0024195555
License Number StateVA
# 6
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0024195555
License Number StateVA
# 7
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number0024195555
License Number StateVA
# 8
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0024195555
License Number StateVA
# 9
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5006879
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: