Individual
MRS. AMELIE P. MCKNEELY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
7777 FOREST LN, DALLAS, TX 75230-2571
(972) 566-7000
Mailing address
7777 FOREST LN, DALLAS, TX 75230-2571
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA11133
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
102I976217
MEDICARE PTAN
AL
05
—
130341
—
AL
01
—
511-17067
BLUE CROSS AND BLUE SHIELD
AL
Enumeration date
11/30/2006
Last updated
04/25/2022
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