Individual
AMY E. TICKLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3200 MACCORKLE AVE SE, SUITE 502, CHARLESTON, WV 25304-1227
(304) 388-5848
(304) 388-9654
Mailing address
104 ALEX LN, CHARLESTON, WV 25304-2952
(304) 734-2040
(304) 734-2047
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
23020
WV
208M00000X
Hospitalist Physician
23020
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810013834
—
WV
01
—
P01045604
MEDICARE RAILROAD
WV
Enumeration date
04/17/2007
Last updated
05/21/2020
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