Provider Demographics
NPI:1245202001
Name:SHORT, AMY C (MD)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:C
Last Name:SHORT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 S WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-6082
Mailing Address - Country:US
Mailing Address - Phone:308-534-4804
Mailing Address - Fax:308-534-0460
Practice Address - Street 1:1115 S WILLOW ST
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-6082
Practice Address - Country:US
Practice Address - Phone:308-534-4804
Practice Address - Fax:308-534-0460
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101234052207V00000X
NE27873207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE27873OtherSTATE MEDICAL LICENSE
KS200638290AMedicaid