Petersen, Amanda D
Petersen, Amanda D is an individual health care provider with primary practice located at 4804 W Clearwater Ave Kadlec Clinic Urgent Care, Kennewick WA 99336. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Medical, which is considered as her primary health care specialty. Petersen, Amanda D can be contacted via phone (509) 942-2355.Contact Information
Primary practice address
4804 W Clearwater Ave Kadlec Clinic Urgent Care
Kennewick WA 99336
Phone: (509) 942-2355
Fax: (509) 222-2355
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Medical | 363AM0700X | PENDING | Washington |
| Physician Assistants & Advanced Practice Nursing Providers / Medical | 363AM0700X | PA60113833 | Washington |
Profile Details
| NPI number | 1528391372 |
|---|---|
| LBN Legal business name | Petersen, Amanda D |
| Credentials | Physician's Assistant Certified (PA-C) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Sep 11th, 2009 |
| Last updated | Jan 22nd, 2014 - about 12 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1528391372 | NPPES |
| Washington | MEDICAID | 1528391372 |
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