Provider Demographics
NPI:1447371737
Name:TROLLEY, AMY LYNN (PAC)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:LYNN
Last Name:TROLLEY
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 BEE ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29401-5703
Mailing Address - Country:US
Mailing Address - Phone:843-577-5011
Mailing Address - Fax:
Practice Address - Street 1:109 BEE ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29401-5703
Practice Address - Country:US
Practice Address - Phone:843-577-5011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC627363AS0400X
NY020341363AS0400X
OH50001943363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0068585OtherMEDICAID
OHH021220OtherMEDICARE
OH720614OtherANTHEM
OH9720708OtherAETNA
OH1632131OtherGATEWAY HEALTH
OH270577733079OtherCARESOURCE
OH779386/713428OtherBUCKEYE MEDICAID/MEDICARE
OHP01238565OtherRAILROAD MEDICARE
OH1447371737OtherMEDICAL MUTUAL
OH610902OtherWELLCARE