Provider Demographics
NPI:1548236862
Name:YOUNG, AMELIA ROSE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:AMELIA
Middle Name:ROSE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:AMELIA
Other - Middle Name:ROSE
Other - Last Name:FARNBACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1250 S. CLEARVIEW AVE #100
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85209
Mailing Address - Country:US
Mailing Address - Phone:480-423-4670
Mailing Address - Fax:480-654-2922
Practice Address - Street 1:1400 S. DOBSON RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202
Practice Address - Country:US
Practice Address - Phone:480-412-3000
Practice Address - Fax:480-654-2922
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-27
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3611363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ3611OtherAZ LICENSE
Q53378Medicare UPIN
NV100507133Medicaid
NV100507134Medicaid