Provider Demographics
NPI:1124206875
Name:PETERSON, AMBER VIGUE (MPAS PAC)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:VIGUE
Last Name:PETERSON
Suffix:
Gender:F
Credentials:MPAS PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:524 SINGING OAKS STE 200
Mailing Address - Street 2:
Mailing Address - City:BULVERDE
Mailing Address - State:TX
Mailing Address - Zip Code:78070-6533
Mailing Address - Country:US
Mailing Address - Phone:830-980-8433
Mailing Address - Fax:830-980-8442
Practice Address - Street 1:524 SINGING OAKS STE 200
Practice Address - Street 2:
Practice Address - City:BULVERDE
Practice Address - State:TX
Practice Address - Zip Code:78070-6533
Practice Address - Country:US
Practice Address - Phone:830-980-8433
Practice Address - Fax:830-980-8442
Is Sole Proprietor?:No
Enumeration Date:2008-02-05
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA05652363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX313381YLPSOtherWELLMED PTAN
TX328984501Medicaid