Provider Demographics
NPI:1215912712
Name:SNOW, AMY GOULEY (PA)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:GOULEY
Last Name:SNOW
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:GOULEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 400
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97709-0400
Mailing Address - Country:US
Mailing Address - Phone:541-727-3376
Mailing Address - Fax:800-514-0191
Practice Address - Street 1:360 SW BOND ST STE 310
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3556
Practice Address - Country:US
Practice Address - Phone:541-727-3376
Practice Address - Fax:800-514-0191
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17111363AM0700X
WA60240552363AM0700X
ORPA179314363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical