Provider Demographics
NPI:1407834500
Name:HEFNER, AMANDA C (MPAS, PAC)
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:C
Last Name:HEFNER
Suffix:
Gender:F
Credentials:MPAS, PAC
Other - Prefix:MRS
Other - First Name:AMANDA
Other - Middle Name:C
Other - Last Name:BRUNSWICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPAS, PAC
Mailing Address - Street 1:700 ACKERMAN RD
Mailing Address - Street 2:SUITE 570
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-293-8566
Mailing Address - Fax:614-293-3381
Practice Address - Street 1:181 TAYLOR AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43203-1779
Practice Address - Country:US
Practice Address - Phone:614-293-8566
Practice Address - Fax:614-293-3381
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.002080363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0112291Medicaid
OH0112291Medicaid