Provider Demographics
NPI:1326583592
Name:GUNTHER, AMBER NICOLE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:NICOLE
Last Name:GUNTHER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:AMBER
Other - Middle Name:NICOLE
Other - Last Name:WEST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:4834 BREEZE DR
Mailing Address - Street 2:
Mailing Address - City:OOLOGAH
Mailing Address - State:OK
Mailing Address - Zip Code:74053-3327
Mailing Address - Country:US
Mailing Address - Phone:918-607-8319
Mailing Address - Fax:
Practice Address - Street 1:2621 E 38TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-8206
Practice Address - Country:US
Practice Address - Phone:918-307-5490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-27
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2766363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKPENDINGOtherPHYSICIAN'S ASSISTANT LICENSE