Provider Demographics
NPI:1487823266
Name:BELL, AMY MARIE (PA)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:MARIE
Last Name:BELL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:AMY
Other - Middle Name:MARIE
Other - Last Name:DEWANE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:285 OLMSTED BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-8731
Mailing Address - Country:US
Mailing Address - Phone:910-295-7246
Mailing Address - Fax:910-222-3168
Practice Address - Street 1:285 OLMSTED BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-8731
Practice Address - Country:US
Practice Address - Phone:910-295-7246
Practice Address - Fax:910-222-3168
Is Sole Proprietor?:No
Enumeration Date:2008-02-26
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-04257363AM0700X
PAMA053266363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007708200003Medicaid