Provider Demographics
NPI:1689078974
Name:NACKERS, AMY ELIZABETH (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:ELIZABETH
Last Name:NACKERS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:AMY
Other - Middle Name:ELIZABETH
Other - Last Name:KNISSEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:9420 N NEWPORT HWY STE 103
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218-1391
Mailing Address - Country:US
Mailing Address - Phone:509-598-7744
Mailing Address - Fax:
Practice Address - Street 1:9420 N. NEWPORT HWY
Practice Address - Street 2:SUITE 103
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218
Practice Address - Country:US
Practice Address - Phone:509-598-7744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-15
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1390363A00000X
WAPA61143707363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1620855Medicaid
AK1620855Medicaid