Provider Demographics
NPI:1790155893
Name:RISMILLER, AMY FRANTZ (PA-C)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:FRANTZ
Last Name:RISMILLER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1100 REID PKWY
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1157
Mailing Address - Country:US
Mailing Address - Phone:765-983-3300
Mailing Address - Fax:765-983-7916
Practice Address - Street 1:1380 CHESTER BLVD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-1907
Practice Address - Country:US
Practice Address - Phone:765-983-3300
Practice Address - Fax:765-983-7916
Is Sole Proprietor?:No
Enumeration Date:2015-10-01
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN10002817A363A00000X
OH50.004441363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical