Provider Demographics
NPI:1750735825
Name:AMEMATSRO, FRED (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:FRED
Middle Name:
Last Name:AMEMATSRO
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 WEXFORD CIR
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27360-4980
Mailing Address - Country:US
Mailing Address - Phone:336-762-0099
Mailing Address - Fax:336-762-0099
Practice Address - Street 1:37 WEXFORD CIR
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:NC
Practice Address - Zip Code:27360-4980
Practice Address - Country:US
Practice Address - Phone:336-762-0099
Practice Address - Fax:336-762-0099
Is Sole Proprietor?:No
Enumeration Date:2016-04-14
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5008578363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health