Provider Demographics
NPI:1184687600
Name:METHVIN, AMY PHELPS (PA-C)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:PHELPS
Last Name:METHVIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:LYNN
Other - Last Name:PHELPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1069 POWDERMILL HILL ROAD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38464
Mailing Address - Country:US
Mailing Address - Phone:931-279-3377
Mailing Address - Fax:
Practice Address - Street 1:326 N LOCUST AVE
Practice Address - Street 2:SUITE B
Practice Address - City:LAWRENCEBURG
Practice Address - State:TN
Practice Address - Zip Code:38464-3516
Practice Address - Country:US
Practice Address - Phone:931-762-9797
Practice Address - Fax:931-762-9798
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPA1430363AS0400X
CA20431363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1508540Medicaid
TN3665270Medicare PIN