Provider Demographics
NPI:1215289384
Name:PETTIS, AMY S (PA-C)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:S
Last Name:PETTIS
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 1:120 E 2ND ST THIRD FLOOR
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16507-1578
Mailing Address - Country:US
Mailing Address - Phone:814-877-8000
Mailing Address - Fax:814-452-2210
Practice Address - Street 1:120 E 2ND ST THIRD FLOOR
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16507-1578
Practice Address - Country:US
Practice Address - Phone:814-877-8000
Practice Address - Fax:814-452-2210
Is Sole Proprietor?:No
Enumeration Date:2012-10-12
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA055831363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant