Provider Demographics
NPI:1972126142
Name:ALLISTON, AMY FAY (FNP, PMHNP, IBCLC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:FAY
Last Name:ALLISTON
Suffix:
Gender:F
Credentials:FNP, PMHNP, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308B S MAIN ST STE 222
Mailing Address - Street 2:
Mailing Address - City:FARMVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23901-1744
Mailing Address - Country:US
Mailing Address - Phone:434-808-9453
Mailing Address - Fax:800-317-0655
Practice Address - Street 1:308B S MAIN ST STE 222
Practice Address - Street 2:
Practice Address - City:FARMVILLE
Practice Address - State:VA
Practice Address - Zip Code:23901-1744
Practice Address - Country:US
Practice Address - Phone:434-808-9453
Practice Address - Fax:800-317-0655
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-22
Last Update Date:2025-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024186591363LP0808X, 363LF0000X
VAL-88133163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant