Individual
MRS. AMBER KEAVEY HUYNH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3000 TOWN CTR STE 1400, SOUTHFIELD, MI 48075-1271
(313) 284-2204
Mailing address
51050 GOLD RIDGE LN, CANTON, MI 48188-3402
(910) 709-0858
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
60797617
WA
363AM0700X
Medical Physician Assistant
5601012443
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1147070
NCCPA ID
—
01
—
5601012443
STATE LICENSE NUMBER
MI
01
—
60797617
STATE LICENSE NUMBER
WA
Enumeration date
02/15/2017
Last updated
09/16/2024
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