Provider Demographics
NPI:1700082401
Name:KNIGHTON, AMY EILEEN (PAC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:EILEEN
Last Name:KNIGHTON
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 80217
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85060-0217
Mailing Address - Country:US
Mailing Address - Phone:602-772-3800
Mailing Address - Fax:480-422-6551
Practice Address - Street 1:3133 E CAMELBACK RD STE 254
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-4538
Practice Address - Country:US
Practice Address - Phone:602-772-3800
Practice Address - Fax:602-772-3801
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5133363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ993082Medicaid
TX8J6344Medicare PIN