Provider Demographics
NPI:1124485321
Name:MCCUMBER, AMELIA SHANE (PA-C)
Entity type:Individual
Prefix:
First Name:AMELIA
Middle Name:SHANE
Last Name:MCCUMBER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 70
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:NE
Mailing Address - Zip Code:68780-0070
Mailing Address - Country:US
Mailing Address - Phone:402-924-3777
Mailing Address - Fax:402-924-3776
Practice Address - Street 1:418 E 5TH ST
Practice Address - Street 2:POB 403
Practice Address - City:ATKINSON
Practice Address - State:NE
Practice Address - Zip Code:68713-4885
Practice Address - Country:US
Practice Address - Phone:402-925-2994
Practice Address - Fax:402-924-3996
Is Sole Proprietor?:No
Enumeration Date:2016-01-20
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1980363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant