Provider Demographics
NPI:1184726580
Name:RAPP, AMY D (PA)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:D
Last Name:RAPP
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:D
Other - Last Name:WYATT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:2065 E SOUTH BLVD STE 204
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36116-2460
Mailing Address - Country:US
Mailing Address - Phone:334-747-7300
Mailing Address - Fax:334-747-7320
Practice Address - Street 1:2065 E SOUTH BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36116-2458
Practice Address - Country:US
Practice Address - Phone:334-281-6990
Practice Address - Fax:334-281-9725
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPA120363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALWY000038256Medicaid
ALWY000038256Medicaid
AL000038256WYAMedicare ID - Type Unspecified