Provider Demographics
NPI:1568022911
Name:CROUSE, AMY (MSN-FNP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:CROUSE
Suffix:
Gender:F
Credentials:MSN-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1424 DAVENPORT CT
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-3678
Mailing Address - Country:US
Mailing Address - Phone:336-778-6373
Mailing Address - Fax:
Practice Address - Street 1:1424 DAVENPORT CT
Practice Address - Street 2:
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-3678
Practice Address - Country:US
Practice Address - Phone:336-778-6373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-18
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCROU-4RAJFD363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily