Provider Demographics
NPI:1497033252
Name:KING, AMANDA JEAN (PA-C)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:JEAN
Last Name:KING
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:LUTZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PAC
Mailing Address - Street 1:335 RADCLIFFE ST
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:PA
Mailing Address - Zip Code:19007-5015
Mailing Address - Country:US
Mailing Address - Phone:215-589-8718
Mailing Address - Fax:888-370-3385
Practice Address - Street 1:4755 OGLETOWN STANTON RD STE 1E50
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19718-5015
Practice Address - Country:US
Practice Address - Phone:302-733-1980
Practice Address - Fax:302-733-1986
Is Sole Proprietor?:No
Enumeration Date:2011-07-28
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC5-0011895363A00000X, 363AS0400X
PAMA054873363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant