Provider Demographics
NPI:1700073798
Name:MCKINNEY, AMBER CHRISTINE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:AMBER
Middle Name:CHRISTINE
Last Name:MCKINNEY
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 1:1630 23RD AVE
Mailing Address - Street 2:SUITE 701
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-6350
Mailing Address - Country:US
Mailing Address - Phone:208-743-4373
Mailing Address - Fax:208-743-3369
Practice Address - Street 1:1630 23RD AVE
Practice Address - Street 2:SUITE 701
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-6350
Practice Address - Country:US
Practice Address - Phone:208-743-4373
Practice Address - Fax:208-743-3369
Is Sole Proprietor?:No
Enumeration Date:2007-10-03
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPA-703363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8469348Medicaid
ID807900800Medicaid
ID807900800Medicaid
ID1665070Medicare PIN