Provider Demographics
NPI:1740255652
Name:LUPTON, AMY LAURA (PA)
Entity type:Individual
Prefix:MISS
First Name:AMY
Middle Name:LAURA
Last Name:LUPTON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 W 15TH ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27889-3565
Mailing Address - Country:US
Mailing Address - Phone:252-975-2667
Mailing Address - Fax:252-975-2507
Practice Address - Street 1:501 W 15TH ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NC
Practice Address - Zip Code:27889-3565
Practice Address - Country:US
Practice Address - Phone:252-975-2667
Practice Address - Fax:252-975-2507
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC102291363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2743987EMedicare PIN