Provider Demographics
NPI:1649287939
Name:HUNTER, MICHELLE K (PA-C)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:K
Last Name:HUNTER
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 1:3901 AVE B
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361
Mailing Address - Country:US
Mailing Address - Phone:308-632-2215
Mailing Address - Fax:308-632-7921
Practice Address - Street 1:3901 AVE B
Practice Address - Street 2:
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361
Practice Address - Country:US
Practice Address - Phone:308-632-2215
Practice Address - Fax:308-632-7921
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1071363A00000X
WY475363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00163932OtherMEDICARE RAILROAD
NE1071OtherSTATE LICENSE
283821AOtherRURAL HEALTH
WYW22741Medicare PIN
283821AOtherRURAL HEALTH
278254Medicare PIN
NE1071OtherSTATE LICENSE
278255Medicare PIN