Provider Demographics
NPI:1750433462
Name:MOEHLENKAMP, AMY E (PA-C)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:E
Last Name:MOEHLENKAMP
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:E
Other - Last Name:HAWKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:925 RED BLUFF DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46814-9082
Mailing Address - Country:US
Mailing Address - Phone:808-294-7641
Mailing Address - Fax:
Practice Address - Street 1:PPG INTEGRATIVE MEDICINE
Practice Address - Street 2:1234 E. DUPONT RD. SUITE 3
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825
Practice Address - Country:US
Practice Address - Phone:260-425-6569
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1072914363A00000X
IN10001507A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN267030024Medicare PIN
VAD000Medicare UPIN