Provider Demographics
NPI:1194107045
Name:POWELL, AMY M (PA-C)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:M
Last Name:POWELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:AMY
Other - Middle Name:M
Other - Last Name:CLEVENGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:135 MIDWAY DR
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-3857
Mailing Address - Country:US
Mailing Address - Phone:814-371-2348
Mailing Address - Fax:
Practice Address - Street 1:135 MIDWAY DR
Practice Address - Street 2:
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-3857
Practice Address - Country:US
Practice Address - Phone:814-371-2348
Practice Address - Fax:814-372-6089
Is Sole Proprietor?:No
Enumeration Date:2015-06-26
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant