Healthcare Provider Details

I. General information

NPI: 1174154355
Provider Name (Legal Business Name): AMANDA ANN STOCKTON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2020
Last Update Date: 02/14/2024
Certification Date: 02/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 4TH ST SW
MASON CITY IA
50401-2800
US

IV. Provider business mailing address

1263 COUNTY ROAD KK
GRATIOT WI
53541-9602
US

V. Phone/Fax

Practice location:
  • Phone: 641-428-7000
  • Fax:
Mailing address:
  • Phone: 319-929-6029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number099496
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number099496
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: