Provider Demographics
NPI:1538133657
Name:PLUMLEE, AMBER D (PA-C, MPAS)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:D
Last Name:PLUMLEE
Suffix:
Gender:F
Credentials:PA-C, MPAS
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:D
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3805 S YELLOW PINE AVE
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74011-1272
Mailing Address - Country:US
Mailing Address - Phone:402-980-8048
Mailing Address - Fax:
Practice Address - Street 1:505 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ULYSSES
Practice Address - State:KS
Practice Address - Zip Code:67880-2135
Practice Address - Country:US
Practice Address - Phone:620-356-1261
Practice Address - Fax:620-356-3846
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-00736363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS15-00736OtherLICENSE #
KS100372190BMedicaid
KSP15858Medicare UPIN
KS100372190BMedicaid