Provider Demographics
NPI:1730598962
Name:MYERS, AMY (BC-APRN, FNP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:MYERS
Suffix:
Gender:F
Credentials:BC-APRN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 TOD AVE SW
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44485-3608
Mailing Address - Country:US
Mailing Address - Phone:330-373-0222
Mailing Address - Fax:
Practice Address - Street 1:716 TOD AVE SW
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44485-3608
Practice Address - Country:US
Practice Address - Phone:330-373-0222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-13
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA16376-NO363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner