1093114076 NPI number — AMY L HUNT PA-C

Table of content: AMY L HUNT PA-C (NPI 1093114076)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093114076 NPI number — AMY L HUNT PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUNT
Provider First Name:
AMY
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PERVIN
Provider Other First Name:
AMY
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1093114076
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/04/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 426
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHANUTE
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66720-0426
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
620-431-4000
Provider Business Mailing Address Fax Number:
620-431-7756

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1407 W. 7TH ST., SUITE #2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHANUTE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-432-5200
Provider Business Practice Location Address Fax Number:
620-431-1192
Provider Enumeration Date:
08/15/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  1501714 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 201101260A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com