Healthcare Provider Details

I. General information

NPI: 1073559563
Provider Name (Legal Business Name): AMANDA D HORRICKS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6488 CHINOOK ST
BONNERS FERRY ID
83805-7515
US

IV. Provider business mailing address

6488 CHINOOK ST
BONNERS FERRY ID
83805-7515
US

V. Phone/Fax

Practice location:
  • Phone: 208-267-8710
  • Fax:
Mailing address:
  • Phone: 208-267-8710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA-797
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: