Provider Demographics
NPI:1356378152
Name:SUMMERS, AMY A (CNP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:A
Last Name:SUMMERS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 MORRIS ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25301-1897
Mailing Address - Country:US
Mailing Address - Phone:304-344-3551
Mailing Address - Fax:304-342-6927
Practice Address - Street 1:415 MORRIS ST
Practice Address - Street 2:SUITE 400
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-1897
Practice Address - Country:US
Practice Address - Phone:304-344-3551
Practice Address - Fax:304-342-6927
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN288177363L00000X
WVRN75515363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000224473OtherANTHEM
OHP37458Medicare UPIN
OHNP08511Medicare ID - Type Unspecified