Provider Demographics
NPI:1306840228
Name:KNOWLTON, AMBER E (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:AMBER
Middle Name:E
Last Name:KNOWLTON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2311 OHIO AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-2559
Mailing Address - Country:US
Mailing Address - Phone:304-422-5114
Mailing Address - Fax:304-422-5751
Practice Address - Street 1:2311 OHIO AVE
Practice Address - Street 2:SUITE A
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-2559
Practice Address - Country:US
Practice Address - Phone:304-422-5114
Practice Address - Fax:304-422-5751
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1129363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810001816Medicaid
Q35122Medicare UPIN