Provider Demographics
NPI:1689616591
Name:SWEET, AMY ELISHA (PA)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:ELISHA
Last Name:SWEET
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 1:8133 MESA DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-8655
Mailing Address - Country:US
Mailing Address - Phone:512-815-9009
Mailing Address - Fax:512-233-5161
Practice Address - Street 1:8133 MESA DR
Practice Address - Street 2:SUITE 200
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-8655
Practice Address - Country:US
Practice Address - Phone:512-815-9009
Practice Address - Fax:512-233-5161
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03779363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX196740801Medicaid
TX196740803Medicaid
TX196740802Medicaid
TX196740803Medicaid
TX8D9249Medicare PIN
TX8D9248Medicare PIN
TX196740801Medicaid
TX8L5379Medicare PIN
TX0080BYMedicare ID - Type UnspecifiedMEDICARE GROUP NUMBER