Individual
AMY JOANNE KNACKENDOFFEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
801 W MAPLE ST, FARMINGTON, NM 87401-5698
(505) 609-2000
Mailing address
PO BOX 844088, DALLAS, TX 75284-4088
(505) 609-2243
(505) 609-2259
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
PA.0006771
CO
363AM0700X
Medical Physician Assistant
PA.0006771
CO
363AM0700X
Medical Physician Assistant
Primary
PA2024-0057
NM
Other
Enumeration date
06/16/2021
Last updated
12/11/2024
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