Provider Demographics
NPI:1700971074
Name:MICK, AMBER ANISE (PA)
Entity Type:Individual
Prefix:MS
First Name:AMBER
Middle Name:ANISE
Last Name:MICK
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3201 UNIVERSITY DR E
Mailing Address - Street 2:STE 205
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-3482
Mailing Address - Country:US
Mailing Address - Phone:979-774-7896
Mailing Address - Fax:979-776-5264
Practice Address - Street 1:3201 UNIVERSITY DR. E
Practice Address - Street 2:STE 205
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-3482
Practice Address - Country:US
Practice Address - Phone:979-774-7896
Practice Address - Fax:979-776-5264
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2012-03-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXPA00745363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical