Provider Demographics
NPI:1902844285
Name:BRUNER, AMY LYNN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:LYNN
Last Name:BRUNER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:LYNN
Other - Last Name:CRIBBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 760
Mailing Address - Street 2:EMERGENCY MEDICINE ASSOCIATES PC
Mailing Address - City:KITTANNING
Mailing Address - State:PA
Mailing Address - Zip Code:16201
Mailing Address - Country:US
Mailing Address - Phone:800-777-2455
Mailing Address - Fax:610-617-6280
Practice Address - Street 1:ONE NOLTE DRIVE
Practice Address - Street 2:ARMSTRONG COUNTY MEMORIAL HOSPITAL
Practice Address - City:KITTANNING
Practice Address - State:PA
Practice Address - Zip Code:16201
Practice Address - Country:US
Practice Address - Phone:724-543-8109
Practice Address - Fax:724-543-8809
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA002446L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP00038120OtherRAILROAD MEDICARE
PAS63522Medicare UPIN
PA069934Medicare ID - Type Unspecified