Provider Demographics
NPI:1093872772
Name:MOORHEAD, AMY JEWEL (PA)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:JEWEL
Last Name:MOORHEAD
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Gender:F
Credentials:PA
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Mailing Address - Street 1:9300 DEWITT LOOP
Mailing Address - Street 2:
Mailing Address - City:FORT BELVOIR
Mailing Address - State:VA
Mailing Address - Zip Code:22060-5285
Mailing Address - Country:US
Mailing Address - Phone:571-231-2191
Mailing Address - Fax:571-231-6607
Practice Address - Street 1:9300 DEWITT LOOP
Practice Address - Street 2:
Practice Address - City:FORT BELVOIR
Practice Address - State:VA
Practice Address - Zip Code:22060-5285
Practice Address - Country:US
Practice Address - Phone:571-231-2191
Practice Address - Fax:712-316-6075
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2023-12-04
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Provider Licenses
StateLicense IDTaxonomies
VA0110005652363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant