Provider Demographics
NPI:1851683916
Name:CUMMINS, AMANDA JANE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:JANE
Last Name:CUMMINS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIRSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43950-7713
Mailing Address - Country:US
Mailing Address - Phone:740-695-2090
Mailing Address - Fax:740-695-4116
Practice Address - Street 1:109 PLAZA DR
Practice Address - Street 2:
Practice Address - City:SAINT CLAIRSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43950-7713
Practice Address - Country:US
Practice Address - Phone:740-695-2090
Practice Address - Fax:740-695-4116
Is Sole Proprietor?:No
Enumeration Date:2011-05-09
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.005861RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH352672Medicaid
WV01358OtherSTATE LICENSE