Provider Demographics
NPI:1588828206
Name:DEARKING, AMY CORINNE (MD)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:CORINNE
Last Name:DEARKING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:CORINNE
Other - Last Name:POST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1528 NORTHWAY DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-1255
Mailing Address - Country:US
Mailing Address - Phone:320-252-0233
Mailing Address - Fax:320-252-1421
Practice Address - Street 1:1528 NORTHWAY DR
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-1255
Practice Address - Country:US
Practice Address - Phone:320-252-0233
Practice Address - Fax:320-252-1421
Is Sole Proprietor?:No
Enumeration Date:2008-07-11
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN51891207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAENROLLEDMedicaid
MNENROLLEDMedicaid
MNP01173520OtherRAILRAOD MEDICARE
MN040000942Medicare PIN