Active NPI
Amanda Smith Clary, CFM
- Mastectomy Fitter
- Henderson, NC
National Provider Identifier
1053859975
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mastectomy Fitter
- License
- CFM03091
- Practice address
- 253 Ruin Creek Rd
Henderson, NC 27536-5916 - Phone
- (252) 492-3404
- Fax
- (252) 430-0670
- NPI assigned
- Feb 11, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mastectomy Fitter | 224900000X | CFM03091 | NC | Primary |
Addresses
Primary practice location
253 Ruin Creek Rd
Henderson, NC 27536-5916
Mailing address
253 Ruin Creek Rd
Henderson, NC 27536-5916
Phone (252) 492-3404
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CFM03091 | NC | MD | Mastectomy Fitter |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1486771200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1486771200000",
"number": "1053859975",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "253 RUIN CREEK RD",
"city": "HENDERSON",
"state": "NC",
"postal_code": "275365916",
"telephone_number": "252-492-3404",
"fax_number": "252-430-0670"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "253 RUIN CREEK RD",
"city": "HENDERSON",
"state": "NC",
"postal_code": "275365916",
"telephone_number": "252-492-3404",
"fax_number": "252-430-0670"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARY",
"first_name": "AMANDA",
"middle_name": "SMITH",
"credential": "CFM",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-02-11",
"last_updated": "2017-02-11",
"status": "A"
},
"taxonomies": [
{
"code": "224900000X",
"taxonomy_group": "",
"desc": "Mastectomy Fitter",
"state": "NC",
"license": "CFM03091",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Henderson, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.