Provider Demographics
NPI:1730661497
Name:MITCH, AMY RAY (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:AMY
Middle Name:RAY
Last Name:MITCH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:624 FALLECKER RD
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16002-0030
Mailing Address - Country:US
Mailing Address - Phone:724-234-5446
Mailing Address - Fax:
Practice Address - Street 1:901 E BRADY ST STE 101
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-4649
Practice Address - Country:US
Practice Address - Phone:724-283-4460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-29
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.006844RX363A00000X
PAMA059888363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant