Provider Demographics
NPI:1982168944
Name:MCCAUL, AMY R (FNP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:R
Last Name:MCCAUL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7400 HUNTINGTON PARK DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-5617
Mailing Address - Country:US
Mailing Address - Phone:614-505-0378
Mailing Address - Fax:
Practice Address - Street 1:7400 HUNTINGTON PARK DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-5617
Practice Address - Country:US
Practice Address - Phone:614-505-0378
Practice Address - Fax:614-505-0399
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-24
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN273181163W00000X
OHAPRN.CNP.024125363LF0000X
OH324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0352958Medicaid
OHRN273181OtherOHIO BOARD OF NURSING RN LICENSE