Individual
AMY L SOUTHARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
60 MAPLE ROAD, WILLIAMSVILLE, NY 14221-2917
(716) 626-5250
(716) 332-2218
Mailing address
60 MAPLE ROAD, WILLIAMSVILLE, NY 14221-2917
(716) 626-5250
(716) 332-2218
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
F3308631
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00026499401
UNIVERA
NY
01
—
000560074006
BCBS OF WNY
NY
01
—
040511000415
FIDELIS
NY
01
—
9512030
INDEPENDENT HEALTH
NY
Enumeration date
04/13/2006
Last updated
12/09/2013
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