Provider Demographics
NPI:1124551718
Name:NEAL, AMY T (PA-C)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:T
Last Name:NEAL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:TIFFIN
Other - Last Name:WILKINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:580 COURT STREET
Mailing Address - Street 2:THE CHESHIRE MEDICAL CENTER - EMERGENCY DEPARTMENT
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431-1718
Mailing Address - Country:US
Mailing Address - Phone:603-354-5454
Mailing Address - Fax:603-354-6535
Practice Address - Street 1:580 COURT STREET
Practice Address - Street 2:THE CHESHIRE MEDICAL CENTER
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431
Practice Address - Country:US
Practice Address - Phone:603-354-5454
Practice Address - Fax:603-354-6535
Is Sole Proprietor?:No
Enumeration Date:2017-04-10
Last Update Date:2017-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1254363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant