Provider Demographics
NPI:1609160936
Name:WOODFIN, AMY ALEXANDER (PA-C)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:ALEXANDER
Last Name:WOODFIN
Suffix:
Gender:F
Credentials:PA-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 1845
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28687-1845
Mailing Address - Country:US
Mailing Address - Phone:336-751-2121
Mailing Address - Fax:336-751-2123
Practice Address - Street 1:375 HOSPITAL ST
Practice Address - Street 2:
Practice Address - City:MOCKSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27028-2086
Practice Address - Country:US
Practice Address - Phone:336-751-2121
Practice Address - Fax:336-751-2123
Is Sole Proprietor?:No
Enumeration Date:2011-06-03
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-02917363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNC0689AMedicare PIN