=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619772845
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AMY C BILICKI FNP-C, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/13/2025
-----------------------------------------------------
Last Update Date | 02/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 127 S POPLAR ST
-----------------------------------------------------
City | WINSTON SALEM
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27101-3755
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-688-4058
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5144 HUNTCLIFF TRL
-----------------------------------------------------
City | WINSTON SALEM
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27104-4435
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-688-4058
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NURSE PRACTITIONER/OWNER
-----------------------------------------------------
Name | AMY CHRISTINA BILICKI
-----------------------------------------------------
Credential | FNP-C
-----------------------------------------------------
Telephone | 336-688-4058
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------