Provider Demographics
NPI:1760668180
Name:LITTRELL, AMY M (PA-C)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:M
Last Name:LITTRELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450B WASHINGTON JACKSON RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:EATON
Mailing Address - State:OH
Mailing Address - Zip Code:45320-7600
Mailing Address - Country:US
Mailing Address - Phone:937-456-8340
Mailing Address - Fax:937-456-8341
Practice Address - Street 1:450B WASHINGTON JACKSON RD
Practice Address - Street 2:SUITE 104
Practice Address - City:EATON
Practice Address - State:OH
Practice Address - Zip Code:45320-7600
Practice Address - Country:US
Practice Address - Phone:937-456-8340
Practice Address - Fax:937-456-8341
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-16
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1071818363A00000X
OH50.002571363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0517711Medicaid
OH0517711Medicaid
OHVO 0533985Medicare PIN