Provider Demographics
NPI:1831216936
Name:FARLEE, AMY J (PA)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:J
Last Name:FARLEE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:J
Other - Last Name:WISEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:3610 RICHMOND CIR STE 100
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-3910
Mailing Address - Country:US
Mailing Address - Phone:308-398-6400
Mailing Address - Fax:
Practice Address - Street 1:10 E 31ST ST
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847-2908
Practice Address - Country:US
Practice Address - Phone:308-865-7555
Practice Address - Fax:308-865-2909
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1313363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant