Provider Demographics
NPI:1083057012
Name:DOTY, AMY L (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:L
Last Name:DOTY
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:453 CLEBURNE BLVD
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:VA
Mailing Address - Zip Code:24084
Mailing Address - Country:US
Mailing Address - Phone:540-629-3751
Mailing Address - Fax:
Practice Address - Street 1:453 CLEBURNE BLVD
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:VA
Practice Address - Zip Code:24084
Practice Address - Country:US
Practice Address - Phone:540-629-3751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-09
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV76215363L00000X
VA0024171073363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner