Provider Demographics
NPI:1083808828
Name:PROKOP, AMIE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:AMIE
Middle Name:
Last Name:PROKOP
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:AMIE
Other - Middle Name:
Other - Last Name:SHAFFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:500 UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-2360
Mailing Address - Country:US
Mailing Address - Phone:717-531-8395
Mailing Address - Fax:717-531-5726
Practice Address - Street 1:500 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-2360
Practice Address - Country:US
Practice Address - Phone:717-531-8395
Practice Address - Fax:717-531-5726
Is Sole Proprietor?:No
Enumeration Date:2007-09-05
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA053136363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA247071Medicare PIN
PA116595Medicare PIN
PACB00663OtherRAILROAD MEDICARE PBA