Provider Demographics
NPI:1619211893
Name:THOMAS, AMANDA GETTIER (FNP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:GETTIER
Last Name:THOMAS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:FAYE
Other - Last Name:GETTIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:PO BOX 602484
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2484
Mailing Address - Country:US
Mailing Address - Phone:910-332-0241
Mailing Address - Fax:910-332-0246
Practice Address - Street 1:1333 S DICKINSON DR
Practice Address - Street 2:SUITE 240
Practice Address - City:LELAND
Practice Address - State:NC
Practice Address - Zip Code:28451-6430
Practice Address - Country:US
Practice Address - Phone:910-332-0241
Practice Address - Fax:910-332-0246
Is Sole Proprietor?:No
Enumeration Date:2012-11-12
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5005929363L00000X, 363LF0000X
NC256313363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7006494Medicaid
NC1619211893Medicaid
NCNCA983BMedicare PIN
NC1619211893Medicaid