Provider Demographics
NPI:1366700056
Name:KNUTHSON, AMBER R (PA-C)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:R
Last Name:KNUTHSON
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 1:2121 E HARMONY RD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528-3400
Mailing Address - Country:US
Mailing Address - Phone:970-482-3328
Mailing Address - Fax:970-482-1433
Practice Address - Street 1:2121 E HARMONY RD
Practice Address - Street 2:SUITE 160
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80528-3400
Practice Address - Country:US
Practice Address - Phone:970-482-3328
Practice Address - Fax:970-482-1433
Is Sole Proprietor?:No
Enumeration Date:2012-05-01
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3393363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO32279825Medicaid
CO316659YLB8Medicare PIN
COCOA107446Medicare PIN