Provider Demographics
NPI:1548246903
Name:WEST, AMY SUE (PA-C)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:SUE
Last Name:WEST
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:SUE
Other - Last Name:WEST
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA
Mailing Address - Street 1:16611 S. 40TH STREET
Mailing Address - Street 2:SUITE #100
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-0563
Mailing Address - Country:US
Mailing Address - Phone:480-610-8366
Mailing Address - Fax:480-833-1653
Practice Address - Street 1:16611 S 40TH ST STE 100
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-0563
Practice Address - Country:US
Practice Address - Phone:480-610-6366
Practice Address - Fax:480-833-1653
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9057363AM0700X
FL9109444363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLQ0282OtherMEDICARE GROOUP
FLQ0282OtherMEDICARE GROOUP