Healthcare Provider Details

I. General information

NPI: 1609422211
Provider Name (Legal Business Name): AMANDA KAY ABOLT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2019
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 S GEAR AVE STE 304
WEST BURLINGTON IA
52655-1681
US

IV. Provider business mailing address

1235 280TH AVE
WEST POINT IA
52656-9240
US

V. Phone/Fax

Practice location:
  • Phone: 319-768-1000
  • Fax:
Mailing address:
  • Phone: 515-710-4172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number107005
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number107005
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: