Provider Demographics
NPI:1942579958
Name:OSBOURN, AMBERLY R (PA)
Entity Type:Individual
Prefix:
First Name:AMBERLY
Middle Name:R
Last Name:OSBOURN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:AMBERLY
Other - Middle Name:R
Other - Last Name:GLASPELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2000 MON HEALTH MEDICAL PARK DR STE 2300
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-1168
Mailing Address - Country:US
Mailing Address - Phone:304-599-8802
Mailing Address - Fax:304-599-5607
Practice Address - Street 1:2000 MON HEALTH MEDICAL PARK DRIVE
Practice Address - Street 2:SUITE 2300
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505
Practice Address - Country:US
Practice Address - Phone:304-599-8802
Practice Address - Fax:304-599-5607
Is Sole Proprietor?:No
Enumeration Date:2011-12-20
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1816363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical