Provider Demographics
NPI:1932298429
Name:BIEDENBACH, AMY M (MS, PA-C)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:M
Last Name:BIEDENBACH
Suffix:
Gender:F
Credentials:MS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:678 PORT NATCHEZ CV W
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-1796
Mailing Address - Country:US
Mailing Address - Phone:706-463-9701
Mailing Address - Fax:
Practice Address - Street 1:678 PORT NATCHEZ CV W
Practice Address - Street 2:
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-1796
Practice Address - Country:US
Practice Address - Phone:706-463-9701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4054363A00000X
GA006236363AS0400X
TN0454363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPA25751Medicare ID - Type Unspecified
OHS79489Medicare UPIN