Provider Demographics
NPI:1689425324
Name:COLBERT, AMAYA (PA)
Entity Type:Individual
Prefix:
First Name:AMAYA
Middle Name:
Last Name:COLBERT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 DRIFTWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-3574
Mailing Address - Country:US
Mailing Address - Phone:504-443-9500
Mailing Address - Fax:
Practice Address - Street 1:2120 DRIFTWOOD BLVD
Practice Address - Street 2:
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-3574
Practice Address - Country:US
Practice Address - Phone:504-443-9500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-29
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical