Provider Demographics
NPI:1841708385
Name:KNOWLES, AMANDA MARIE (PAC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:MARIE
Last Name:KNOWLES
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4570 S EASTERN AVE
Mailing Address - Street 2:SUITE #21
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-6183
Mailing Address - Country:US
Mailing Address - Phone:702-733-6033
Mailing Address - Fax:702-733-7292
Practice Address - Street 1:4570 S EASTERN AVE
Practice Address - Street 2:SUITE #21
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-6183
Practice Address - Country:US
Practice Address - Phone:702-733-6033
Practice Address - Fax:702-733-7292
Is Sole Proprietor?:No
Enumeration Date:2018-01-18
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA19352255A2300X, 363A00000X
NV05062852255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer