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NPI Code Detail

MEDICARE: AMY G CANARY PAC

MEDICARE: AMY G CANARY PAC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AM0700XMedical Physician AssistantPA292KY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1407829740
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMY G CANARY PAC
Provider Business Mailing Address
First Line : PO BOX 550
Second Line :
City : VANCEBURG
State : KY
Zip : 41179-0550
Country : US
Telephone Number : 606-796-3029
Fax Number : 606-796-6221
Provider Business Practice Location Address
First Line : 211 KY 59
Second Line :
City : VANCEBURG
State : KY
Zip : 41179-7647
Country : US
Telephone Number : 606-796-3029
Fax Number : 606-796-6221
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/08/2006
Last Update Date : 09/08/2025

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Directions to “ AMY G CANARY PAC” Practice Location

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