Provider Demographics
NPI:1821327974
Name:JAY, AMELIA S (RN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:AMELIA
Middle Name:S
Last Name:JAY
Suffix:
Gender:F
Credentials:RN, FNP-BC
Other - Prefix:
Other - First Name:AMYE
Other - Middle Name:S
Other - Last Name:JAY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2215 NASHVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1105
Mailing Address - Country:US
Mailing Address - Phone:806-725-5844
Mailing Address - Fax:806-723-6532
Practice Address - Street 1:3702 21ST ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410
Practice Address - Country:US
Practice Address - Phone:806-795-2751
Practice Address - Fax:806-795-8464
Is Sole Proprietor?:No
Enumeration Date:2009-12-21
Last Update Date:2018-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX734097363LF0000X
TXAP118514363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1821327974OtherFIRSTCARE
TX220025506Medicaid
TX8HV786OtherBCBS
TX380398YKT8OtherMEDICARE
NM41100379Medicaid