Provider Demographics
NPI:1558620856
Name:SPAHN, AMANDA LEAH (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:LEAH
Last Name:SPAHN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8101 MCCLURE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72916-6044
Mailing Address - Country:US
Mailing Address - Phone:479-459-6528
Mailing Address - Fax:
Practice Address - Street 1:8101 MCCLURE DR STE 100
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72916-6044
Practice Address - Country:US
Practice Address - Phone:479-459-6528
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-08
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP-T1217363A00000X
ARPA-476363A00000X, 207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant