Provider Demographics
NPI:1124003009
Name:WOOD, AMY LYNN (PA-C)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LYNN
Last Name:WOOD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 S BUTLER ST
Mailing Address - Street 2:
Mailing Address - City:CORYDON
Mailing Address - State:IA
Mailing Address - Zip Code:50060-1734
Mailing Address - Country:US
Mailing Address - Phone:641-872-3675
Mailing Address - Fax:
Practice Address - Street 1:417 S EAST ST
Practice Address - Street 2:SUITE #100
Practice Address - City:CORYDON
Practice Address - State:IA
Practice Address - Zip Code:50060-1860
Practice Address - Country:US
Practice Address - Phone:641-872-2063
Practice Address - Fax:641-872-2070
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001295363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAP34310Medicare UPIN
IAI3175Medicare ID - Type Unspecified