Provider Demographics
NPI:1407360191
Name:PINTADO, AMY MELISSA (PA-C)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:MELISSA
Last Name:PINTADO
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 1:2424 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72801-2531
Mailing Address - Country:US
Mailing Address - Phone:479-858-1117
Mailing Address - Fax:800-663-5540
Practice Address - Street 1:2424 W MAIN ST
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801-2531
Practice Address - Country:US
Practice Address - Phone:479-858-1117
Practice Address - Fax:800-663-5540
Is Sole Proprietor?:No
Enumeration Date:2017-11-17
Last Update Date:2017-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT2017-057363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant