Provider Demographics
NPI:1912446543
Name:HUYNH, AMBER KEAVEY (PA-C)
Entity type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:KEAVEY
Last Name:HUYNH
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 1:51050 GOLD RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-3402
Mailing Address - Country:US
Mailing Address - Phone:910-709-0858
Mailing Address - Fax:
Practice Address - Street 1:3000 TOWN CTR STE 1400
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-1271
Practice Address - Country:US
Practice Address - Phone:313-284-2204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-15
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601012443363AM0700X
WA60797617363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5601012443OtherSTATE LICENSE NUMBER
WA60797617OtherSTATE LICENSE NUMBER
1147070OtherNCCPA ID