MRS. AMY PETTICREW (NPI# 1801287610) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1801287610 |
| Entity Type | Individual |
| Full Name | MRS. AMY PETTICREW |
| Other Name | AMY ELIZABETH DIETZEN |
| Credential | PA-C |
| Practice Address |
6324 Fairview Rd Suite 201 Charlotte NC 28210-3271 |
| Mailing Address |
Po Box 60447 Suite 200 Charlotte NC 28260-0447 |
| Practice Telephone | 7043840588 |
| Mailing Telephone | 7043840588 |
| Enumeration Date | 2015-02-16 |
| Last Update Date | 2020-10-26 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 0010-05569 | NC | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
6324 FAIRVIEW RD SUITE 201 |
| City | CHARLOTTE |
| State | NC |
| Zip Code | 28210-3271 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750380549 | William E Porter | Obstetrics & Gynecology | 6324 Fairview Rd, Suite 390, Charlotte, NC 28210-3271 | 2005-07-14 |
| 1184163859 | Cary Probst | Physician Assistant | 6324 Fairview Rd, Suite 390, Charlotte, NC 28210-3271 | 2017-02-15 |
| 1457710436 | Novant Medical Group Inc | Psychiatry & Neurology | 6324 Fairview Rd, Suite 350, Charlotte, NC 28210-3271 | 2016-02-18 |
| 1174991871 | Novant Medical Group, Inc | Obstetrics & Gynecology | 6324 Fairview Rd, Suite 390, Charlotte, NC 28210-3271 | 2015-09-11 |
| 1093101222 | Sashalee Stewart | Psychiatry & Neurology | 6324 Fairview Rd, Charlotte, NC 28210-3271 | 2015-04-14 |
| 1790110484 | Laboratory Corporation of America Holdings | Clinical Medical Laboratory | 6324 Fairview Rd, Charlotte, NC 28210-3271 | 2013-09-12 |
| 1023458767 | Amy Smith Medlin | Social Worker | 6324 Fairview Rd, Suite 350, Charlotte, NC 28210-3271 | 2013-06-26 |
| 1710322367 | Daniel Scott Donner | Pediatrics | 6324 Fairview Rd, Suite 350, Charlotte, NC 28210-3271 | 2013-05-08 |
| 1447414925 | Novant Medical Group, Inc. | Obstetrics & Gynecology | 6324 Fairview Rd, Ste 390, Charlotte, NC 28210-4173 | 2008-07-15 |
| 1467644021 | Genevieve Noel Brauning | Family Medicine | 6324 Fairview Rd, Suite 201, Charlotte, NC 28210-4278 | 2007-08-16 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952920860 | Rx Care 14 LLC | Pharmacy | 7701 Sharon Lakes Road, Suite H, Charlotte, NC 28210 | 2020-04-10 |
| 1427697622 | David Durant Dinsmore | Nurse Anesthetist, Certified Registered | Atrium Health Pineville, 10628 Park Road, Charlotte, NC 28210 | 2020-01-06 |
| 1790256964 | Tele Phys Inc | Internal Medicine | 10035 Park Center Dr., Ste 100, Charlotte, NC 28210 | 2018-12-16 |
| 1104395896 | Bridgett Williams | Behavior Technician | 7806 Andover Woods Drive, Charlotte, NC 28210 | 2018-11-26 |
| 1053880518 | Low-t Physicians Professional Association | Internal Medicine | 10430 Park Road Suite 100a, Charlotte, NC 28210 | 2018-11-14 |
| 1053895102 | Carolinas Medical Equipment LLC | Durable Medical Equipment & Medical Supplies | 7701 Sharon Lakes Blvd, Ste A., Charlotte, NC 28210 | 2018-09-24 |
| 1679066658 | Afc Urgent Care and Family Care of Wnc, Pllc | Clinic/Center | 10102 Johnston Rd, Charlotte, NC 28210 | 2018-06-13 |
| 1346777018 | Hopeway Foundation | Clinic/Center | 1717 Sharon Road West, Charlotte, NC 28210 | 2017-05-12 |
| 1891154688 | Jessie Lee Ogienko | Social Worker | 5960 Fairview Rd Ste 328, Charlotte, NC 28210 | 2016-02-22 |
| 1699151985 | Carolina Complete Psychiatry, Pllc | Physician Assistant | 5950 Fairview Road, Suite 708, Charlotte, NC 28210 | 2015-08-10 |
| Find all providers in zip 28210 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396351607 | Michael James Blackwell | Physician Assistant | 501 Billingsley Rd Ste B, Charlotte, NC 28211-1009 | 2020-09-22 |
| 1598371320 | Jonathan Byron Lively | Physician Assistant | 1000 Blythe Blvd Fl 3, Charlotte, NC 28203-5812 | 2020-09-17 |
| 1902415532 | Jacqueline Ellen Leyrer | Physician Assistant | 2630 E 7th St Ste 200, Charlotte, NC 28204-4319 | 2020-07-29 |
| 1750908380 | Whitney Debroy | Physician Assistant | 125 W Tremont Ave Unit 726, Charlotte, NC 28203-5551 | 2020-06-30 |
| 1972129302 | Ashley Nicole Short | Physician Assistant | 1022 E Worthington Ave, Charlotte, NC 28203-5760 | 2020-06-22 |
| 1558985176 | Courtney Claugus | Physician Assistant | 300 E Park Ave Unit 7, Charlotte, NC 28203-4774 | 2020-05-29 |
| 1467071738 | Patrick James Quinn | Physician Assistant | 2036 Millerton Ave Apt 4311, Charlotte, NC 28208-5290 | 2020-04-15 |
| 1225660301 | Sunil Ranchhod Ghodasara | Physician Assistant | 1001 Blythe Blvd Ste 403, Charlotte, NC 28203-5863 | 2020-02-06 |
| 1225668601 | Emily Rebecca Markey | Physician Assistant | 355 W Mlk Blvd Apt 1112, Charlotte, NC 28202-0043 | 2020-01-24 |
| 1639719586 | Abosede Elizabeth Adamson | Physician Assistant | 3101 Amesbury Hill Dr, Charlotte, NC 28269-8951 | 2020-01-08 |
| Find all providers in CHARLOTTE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.