Provider Demographics
NPI:1306870126
Name:WORTHING, AMY L (PA)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:L
Last Name:WORTHING
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:2900 HANNAH BLVD STE 212
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-5382
Mailing Address - Country:US
Mailing Address - Phone:517-319-1831
Mailing Address - Fax:517-664-2930
Practice Address - Street 1:2900 HANNAH BLVD STE 212
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-5382
Practice Address - Country:US
Practice Address - Phone:517-319-1831
Practice Address - Fax:517-664-2930
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2010-07-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5601002960363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1038858OtherMCLAREN HEALTH PLAN-MEDICAID
MI1038858OtherMCLAREN HEALTH ADVANTAGE
MI2053313130OtherBLUE CROSS BLUE SHIELD
MI1038858OtherMCLAREN HEALTH PLAN-COMMERCIAL
MI7965762OtherAETNA
MIP00283897OtherRAILROAD MEDICARE
MI1038858OtherMCLAREN HEALTH PLAN-MEDICAID
MI1038858OtherMCLAREN HEALTH PLAN-COMMERCIAL