Provider Demographics
NPI:1225059843
Name:HARNISH, AMY J (MD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:J
Last Name:HARNISH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 20970
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82003-7020
Mailing Address - Country:US
Mailing Address - Phone:307-778-2577
Mailing Address - Fax:307-635-2131
Practice Address - Street 1:1950 BLUEGRASS CIR
Practice Address - Street 2:SUITE 200
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-7323
Practice Address - Country:US
Practice Address - Phone:307-778-2577
Practice Address - Fax:307-635-2131
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WY5860A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY304177OtherBLUE SHIELD
WY990012349OtherRAILROAD MEDICARE
WY111897800Medicaid
WY00269OtherWINHEALTH PARTNERS
WY82009B002OtherWPS TRIWEST
WY111897800Medicaid