Healthcare Provider Details

I. General information

NPI: 1619887551
Provider Name (Legal Business Name): AMY HISE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

628 E 12TH ST
WASHINGTON NC
27889-3409
US

IV. Provider business mailing address

345 E 13TH ST
WASHINGTON NC
27889-3729
US

V. Phone/Fax

Practice location:
  • Phone: 252-975-4100
  • Fax:
Mailing address:
  • Phone: 757-754-5406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number9304741
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: