Healthcare Provider Details

I. General information

NPI: 1821455080
Provider Name (Legal Business Name): AMY NANCY JEAN BELOTT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2016
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

618 PLEASANTVILLE RD STE 202
LANCASTER OH
43130-3346
US

IV. Provider business mailing address

641 HILL RD N SUITE A
PICKERINGTON OH
43147-9346
US

V. Phone/Fax

Practice location:
  • Phone: 740-681-9020
  • Fax: 740-681-9112
Mailing address:
  • Phone: 614-833-0880
  • Fax: 614-833-6767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.004560RX
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number50.004560RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: