Provider Demographics
NPI:1033179106
Name:KNOWLES, AMANDA LYNN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:LYNN
Last Name:KNOWLES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:AMANDA
Other - Middle Name:LYNN
Other - Last Name:BRUSCHI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:10024 NE 145TH ST
Mailing Address - Street 2:
Mailing Address - City:JONES
Mailing Address - State:OK
Mailing Address - Zip Code:73049-4945
Mailing Address - Country:US
Mailing Address - Phone:405-820-4315
Mailing Address - Fax:
Practice Address - Street 1:2821 NW 50TH ST STE 150
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-8013
Practice Address - Country:US
Practice Address - Phone:405-820-4315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1471363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200075020AMedicaid
OKOK402524Medicare PIN
OKQ59315Medicare UPIN