Provider Demographics
NPI:1306371521
Name:NEAL, AMY (FNP-C)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:NEAL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 YADKINVILLE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:MOCKSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27028-6945
Mailing Address - Country:US
Mailing Address - Phone:336-296-3101
Mailing Address - Fax:336-296-3102
Practice Address - Street 1:417 E STATESVILLE AVE
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28115-2590
Practice Address - Country:US
Practice Address - Phone:704-663-3063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-25
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024174670363LF0000X
NC5009449363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily