Provider Demographics
NPI:1447686886
Name:GERKE, AMELIA (PA-C)
Entity type:Individual
Prefix:
First Name:AMELIA
Middle Name:
Last Name:GERKE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:340 W LINCOLN ST
Mailing Address - Street 2:SUITE 540
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62220-1900
Mailing Address - Country:US
Mailing Address - Phone:618-222-1341
Mailing Address - Fax:618-222-1487
Practice Address - Street 1:340 W LINCOLN ST
Practice Address - Street 2:SUITE 540
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62220-1900
Practice Address - Country:US
Practice Address - Phone:618-222-1341
Practice Address - Fax:618-222-1487
Is Sole Proprietor?:No
Enumeration Date:2013-09-17
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL085-004084363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant