Individual
MRS. AMY MAXSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA C
Contact information
Practice address
535 E MAIN ST STE A, LANDER, WY 82520-3424
(307) 233-0553
(307) 337-9029
Mailing address
535 E MAIN ST STE A, LANDER, WY 82520-3424
(307) 233-0553
(307) 337-9029
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
321
WY
363AM0700X
Medical Physician Assistant
8722
AZ
363AM0700X
Medical Physician Assistant
MD1123075
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103077
—
AZ
05
—
120542100
—
WY
01
—
314523
BSWY
WY
01
—
605960009
FBL
WY
01
—
Z265974
MEDICARE
AZ
Enumeration date
09/01/2006
Last updated
09/19/2025
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