1972747848 NPI number — MS. AMY TAYLOR AVERY CRNP

Table of content: MS. AMY TAYLOR AVERY CRNP (NPI 1972747848)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972747848 NPI number — MS. AMY TAYLOR AVERY CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AVERY
Provider First Name:
AMY
Provider Middle Name:
TAYLOR
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
CRNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WILLITS
Provider Other First Name:
AMY TAYLOR
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1972747848
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/05/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
909 RIDGEBROOK RD STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPARKS GLENCOE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21152-9477
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
443-383-9300
Provider Business Mailing Address Fax Number:
717-249-9332

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
905 TOWER RD STE 3188
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRISTOL
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19007-3116
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-383-9300
Provider Business Practice Location Address Fax Number:
855-866-8710
Provider Enumeration Date:
04/23/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  RN542564 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: SP007702 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)