Provider Demographics
NPI:1588461248
Name:KING, AMANDA RAE (PA-C)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:RAE
Last Name:KING
Suffix:
Gender:
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 1:2217 CHESTERFIELD DR
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37803-6536
Mailing Address - Country:US
Mailing Address - Phone:812-699-0062
Mailing Address - Fax:812-699-0062
Practice Address - Street 1:2217 CHESTERFIELD DR
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37803-6536
Practice Address - Country:US
Practice Address - Phone:812-699-0062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-28
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical