Provider Demographics
NPI:1689828444
Name:MCGARRY, AMANDA KAYE (PA-C)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:KAYE
Last Name:MCGARRY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:AMANDA
Other - Middle Name:KAYE
Other - Last Name:COLLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:205 PAGE ROAD
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-8798
Mailing Address - Country:US
Mailing Address - Phone:910-295-5511
Mailing Address - Fax:
Practice Address - Street 1:15 REGIONAL DR
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-8850
Practice Address - Country:US
Practice Address - Phone:910-295-9207
Practice Address - Fax:910-235-3432
Is Sole Proprietor?:No
Enumeration Date:2008-11-06
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC148128363A00000X
NC0010-01335363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP01162080OtherR/R MEDICARE
NCFH4001250OtherFIRST MEDICARE DIRECT
NCFH4001250OtherFIRST CAROLINA CARE, INC
NCFH4001250OtherFIRST CAROLINA CARE, INC