Provider Demographics
NPI:1134451206
Name:PUCKETT-LAWSON, AMY LEIGH (FNP-C)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LEIGH
Last Name:PUCKETT-LAWSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 751803
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1803
Mailing Address - Country:US
Mailing Address - Phone:336-719-6100
Mailing Address - Fax:
Practice Address - Street 1:2133 ROCKFORD ST STE 1400
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030-6594
Practice Address - Country:US
Practice Address - Phone:336-719-0398
Practice Address - Fax:336-719-0494
Is Sole Proprietor?:No
Enumeration Date:2010-02-01
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024168630363LF0000X
NC5008637363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0024168630OtherVA LICENSE