Provider Demographics
NPI:1902113541
Name:THORPE, AMELIA TABOR (CNP)
Entity Type:Individual
Prefix:
First Name:AMELIA
Middle Name:TABOR
Last Name:THORPE
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:AMELIA
Other - Middle Name:ANN
Other - Last Name:TABOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12000 RETAIL DR
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-7353
Mailing Address - Country:US
Mailing Address - Phone:919-761-1002
Mailing Address - Fax:
Practice Address - Street 1:12000 RETAIL DR
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-7353
Practice Address - Country:US
Practice Address - Phone:919-761-1002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-02
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5006875363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3091416Medicaid
OH3091416Medicaid