Provider Demographics
NPI:1639279714
Name:MCDEVITT, AMY ZANGE (NP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:ZANGE
Last Name:MCDEVITT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:C
Other - Last Name:ZANGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 751649
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1649
Mailing Address - Country:US
Mailing Address - Phone:843-789-1620
Mailing Address - Fax:843-724-2440
Practice Address - Street 1:2097 HENRY TECKLENBURG DR STE 201W
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-5739
Practice Address - Country:US
Practice Address - Phone:843-402-1211
Practice Address - Fax:843-606-8088
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2978363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP1037Medicaid
P00361701OtherRR MEDICARE
SCNP1037Medicaid
SCQ72857Medicare UPIN
P00361701OtherRR MEDICARE