Provider Demographics
NPI:1730550237
Name:GORMAN, AMY DRAKEFORD (FNP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:DRAKEFORD
Last Name:GORMAN
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 1:902 KIRKWOOD AVE NW
Mailing Address - Street 2:
Mailing Address - City:LENOIR
Mailing Address - State:NC
Mailing Address - Zip Code:28645-5121
Mailing Address - Country:US
Mailing Address - Phone:828-754-0101
Mailing Address - Fax:828-757-0402
Practice Address - Street 1:902 KIRKWOOD AVE NW
Practice Address - Street 2:
Practice Address - City:LENOIR
Practice Address - State:NC
Practice Address - Zip Code:28645-5121
Practice Address - Country:US
Practice Address - Phone:828-754-0101
Practice Address - Fax:828-757-0402
Is Sole Proprietor?:No
Enumeration Date:2015-10-09
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5008086363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner