Provider Demographics
NPI:1528607108
Name:SEYMORE, AMIE RAINA (AGACNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:AMIE
Middle Name:RAINA
Last Name:SEYMORE
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:MRS
Other - First Name:AMIE
Other - Middle Name:RAINA
Other - Last Name:COOKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 336
Mailing Address - Street 2:
Mailing Address - City:WADDELL
Mailing Address - State:AZ
Mailing Address - Zip Code:85355-0336
Mailing Address - Country:US
Mailing Address - Phone:480-621-1696
Mailing Address - Fax:
Practice Address - Street 1:4140 N 108TH AVE STE 134
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-5466
Practice Address - Country:US
Practice Address - Phone:623-295-4901
Practice Address - Fax:623-266-3980
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-31
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ235955363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care