Provider Demographics
NPI:1922175702
Name:KNIGHT, AMY MALONE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:MALONE
Last Name:KNIGHT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:AMY
Other - Middle Name:MALONE
Other - Last Name:SIMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:27702 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1030
Mailing Address - Country:US
Mailing Address - Phone:708-862-7674
Mailing Address - Fax:708-503-3993
Practice Address - Street 1:11250 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-4116
Practice Address - Country:US
Practice Address - Phone:773-779-7500
Practice Address - Fax:773-779-9669
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085001532363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP30759Medicare UPIN
IL703710Medicare ID - Type Unspecified