Provider Demographics
NPI:1043676109
Name:STITES, AMY J (PA-C)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:J
Last Name:STITES
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:1228 TOWANDA AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61701-3469
Mailing Address - Country:US
Mailing Address - Phone:309-454-5900
Mailing Address - Fax:309-454-2820
Practice Address - Street 1:1228 TOWANDA AVE STE 1
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701-3469
Practice Address - Country:US
Practice Address - Phone:309-454-5900
Practice Address - Fax:309-454-2820
Is Sole Proprietor?:No
Enumeration Date:2016-01-05
Last Update Date:2024-06-28
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Provider Licenses
StateLicense IDTaxonomies
IL085005783363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant