Provider Demographics
NPI:1720021942
Name:PAGE, AMY LYNN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:LYNN
Last Name:PAGE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:LYNN
Other - Last Name:PROBST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 617
Mailing Address - Street 2:
Mailing Address - City:BALLINGER
Mailing Address - State:TX
Mailing Address - Zip Code:76821-0617
Mailing Address - Country:US
Mailing Address - Phone:325-365-5737
Mailing Address - Fax:325-365-2405
Practice Address - Street 1:2001 HUTCHINS AVE
Practice Address - Street 2:SUITE C
Practice Address - City:BALLINGER
Practice Address - State:TX
Practice Address - Zip Code:76821-4452
Practice Address - Country:US
Practice Address - Phone:325-365-5737
Practice Address - Fax:325-365-2405
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03906363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB159266OtherMEDICARE PTAN
TX342315401Medicaid