Provider Demographics
NPI:1669737425
Name:NOLD, AMY ANN (PA-C)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:ANN
Last Name:NOLD
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 1:400 HOSPITAL DR STE 111
Mailing Address - Street 2:
Mailing Address - City:CORSICANA
Mailing Address - State:TX
Mailing Address - Zip Code:75110-2489
Mailing Address - Country:US
Mailing Address - Phone:903-641-3815
Mailing Address - Fax:903-641-3863
Practice Address - Street 1:400 HOSPITAL DR STE 210
Practice Address - Street 2:
Practice Address - City:CORSICANA
Practice Address - State:TX
Practice Address - Zip Code:75110-2489
Practice Address - Country:US
Practice Address - Phone:903-641-4835
Practice Address - Fax:903-641-4846
Is Sole Proprietor?:No
Enumeration Date:2012-07-09
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA07877363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3043168-03Medicaid
8N0473OtherBCBS
TX3043168-01Medicaid
TX3043168-01Medicaid
TXTXB158936Medicare PIN