Provider Demographics
NPI:1992150817
Name:KWAN, AMANDA BUCHER (PA-C)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:BUCHER
Last Name:KWAN
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 1:8595 PICARDY AVE STE 235
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-0610
Mailing Address - Country:US
Mailing Address - Phone:225-381-2615
Mailing Address - Fax:225-381-2638
Practice Address - Street 1:8595 PICARDY AVE STE 235
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-0610
Practice Address - Country:US
Practice Address - Phone:225-381-2615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-28
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA009077500OtherDRIVERS LICENSE NUMBER
LA2420739Medicaid
LA302198OtherPA LICENSE
LA504555YJ6VMedicare PIN