Provider Demographics
NPI:1518900570
Name:MUNCY, AMY (NP-C)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:MUNCY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1475
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSON
Mailing Address - State:WV
Mailing Address - Zip Code:25661-1475
Mailing Address - Country:US
Mailing Address - Phone:304-235-3993
Mailing Address - Fax:304-235-3993
Practice Address - Street 1:260 S MAYO TRL
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-1520
Practice Address - Country:US
Practice Address - Phone:606-437-7327
Practice Address - Fax:606-432-9428
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV56357207P00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVPENDINGMedicaid
PENDINGMedicare UPIN
WVPENDINGMedicaid