Provider Demographics
NPI:1316136351
Name:BYERS, AMANDA BETH (PA-C)
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:BETH
Last Name:BYERS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1 MERCADO ST STE 200
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-7308
Mailing Address - Country:US
Mailing Address - Phone:970-375-3643
Mailing Address - Fax:970-375-0007
Practice Address - Street 1:1 MERCADO ST STE 200
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301
Practice Address - Country:US
Practice Address - Phone:970-375-3643
Practice Address - Fax:970-375-0007
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-16
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA05445207XS0114X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8Y3146OtherBCBS
TX142946601Medicaid
TX8Y3146OtherBCBS