Provider Demographics
NPI:1043545155
Name:HAUGHT, AMY KATHRYN (NP-BC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:KATHRYN
Last Name:HAUGHT
Suffix:
Gender:F
Credentials:NP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 WOODCREST LN
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25314-2472
Mailing Address - Country:US
Mailing Address - Phone:304-345-2255
Mailing Address - Fax:304-345-2112
Practice Address - Street 1:117 7TH AVE
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25303-1417
Practice Address - Country:US
Practice Address - Phone:304-345-2255
Practice Address - Fax:304-345-2112
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-07
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV006203363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner