Provider Demographics
NPI:1184785982
Name:JAY, AMY L (PA-C)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:L
Last Name:JAY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:L
Other - Last Name:KALCZYNSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:246 PLEASANT ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-2548
Mailing Address - Country:US
Mailing Address - Phone:603-224-5200
Mailing Address - Fax:603-224-5091
Practice Address - Street 1:246 PLEASANT ST
Practice Address - Street 2:SUITE 210
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-2548
Practice Address - Country:US
Practice Address - Phone:603-224-5200
Practice Address - Fax:603-224-5091
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0831363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q56305Medicare UPIN
TX2028854-01Medicaid
TX8L13397Medicare PIN
TX8Y9838OtherBLUE CROSS BLUE SHIELD OF TEXAS