Healthcare Provider Details

I. General information

NPI: 1184270563
Provider Name (Legal Business Name): AMY ELIZABETH KUHLE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2019
Last Update Date: 11/29/2023
Certification Date: 11/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 GOVE ST
EAST BOSTON MA
02128-1920
US

IV. Provider business mailing address

10 GOVE ST
EAST BOSTON MA
02128-1920
US

V. Phone/Fax

Practice location:
  • Phone: 617-569-5800
  • Fax: 617-568-4685
Mailing address:
  • Phone: 617-569-5800
  • Fax: 617-568-4756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9416
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: