Provider Demographics
NPI:1275537037
Name:PHARR, AMY R (APRN, FPMHNP-C)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:R
Last Name:PHARR
Suffix:
Gender:F
Credentials:APRN, FPMHNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:861 LAKE RD
Mailing Address - Street 2:
Mailing Address - City:LOTTSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22511-2667
Mailing Address - Country:US
Mailing Address - Phone:804-246-4942
Mailing Address - Fax:843-299-2474
Practice Address - Street 1:268 NORTHUMBERLAND HWY
Practice Address - Street 2:
Practice Address - City:CALLAO
Practice Address - State:VA
Practice Address - Zip Code:22435-2222
Practice Address - Country:US
Practice Address - Phone:804-246-4942
Practice Address - Fax:843-299-2474
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-09
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200913363L00000X, 363LP0808X
VA0024185787363LP0808X, 363LF0000X
FLAPRN11010917363LP0808X
SC24387APRN363LP0808X
NY403874363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3144AMedicare PIN
NC2806026AMedicare ID - Type UnspecifiedPROVIDER NUMBER
NCP57152Medicare UPIN