Provider Demographics
NPI:1811986052
Name:HAWTHORNE, AMY B (PA-C)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:B
Last Name:HAWTHORNE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:AMY
Other - Middle Name:LOUISE
Other - Last Name:BRYANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1215 DUFF AVE
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-3014
Mailing Address - Country:US
Mailing Address - Phone:515-239-4431
Mailing Address - Fax:515-239-4742
Practice Address - Street 1:3600 LINCOLN WAY
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50014-7595
Practice Address - Country:US
Practice Address - Phone:515-239-4492
Practice Address - Fax:515-663-4836
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001226363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI15129Medicare ID - Type Unspecified
IAS96542Medicare UPIN