Provider Demographics
NPI:1609422211
Name:ABOLT, AMANDA KAY (PA-C)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:KAY
Last Name:ABOLT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1235 280TH AVE
Mailing Address - Street 2:
Mailing Address - City:WEST POINT
Mailing Address - State:IA
Mailing Address - Zip Code:52656-9240
Mailing Address - Country:US
Mailing Address - Phone:515-710-4172
Mailing Address - Fax:
Practice Address - Street 1:1221 S GEAR AVE STE 304
Practice Address - Street 2:
Practice Address - City:WEST BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52655-1681
Practice Address - Country:US
Practice Address - Phone:319-768-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-11
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA107005207RP1001X, 363AM0700X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty