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NPI Code Detail

MEDICARE: MRS. AMY S. IVEY C.P.N.P.

MEDICARE: MRS. AMY S. IVEY C.P.N.P.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0200XPediatric Nurse Practitioner75718NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1102767OTHERNCNURSING LICENSE

General Provider Information

NPI Number : 1770558868
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. AMY S. IVEY C.P.N.P.
Provider Business Mailing Address
First Line : 195 W ILLINOIS AVE
Second Line :
City : SOUTHERN PINES
State : NC
Zip : 28387-5808
Country : US
Telephone Number : 910-692-2444
Fax Number : 910-692-3651
Provider Business Practice Location Address
First Line : 195 W ILLINOIS AVE
Second Line :
City : SOUTHERN PINES
State : NC
Zip : 28387-5808
Country : US
Telephone Number : 910-692-2444
Fax Number : 910-692-3651
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/22/2006
Last Update Date : 07/08/2007

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