Healthcare Provider Details

I. General information

NPI: 1053364935
Provider Name (Legal Business Name): AMANDA B SEGARS-HUFFSTETLER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA BROOKE SEGARS PA-C

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 08/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

716 FIRST AVENUE SOUTH
OKANOGAN WA
98840-9679
US

IV. Provider business mailing address

PO BOX 1340
OKANOGAN WA
98840-1340
US

V. Phone/Fax

Practice location:
  • Phone: 509-422-5700
  • Fax: 509-422-7680
Mailing address:
  • Phone: 509-422-5700
  • Fax: 509-422-7680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA60212953
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: