Provider Demographics
NPI:1245332337
Name:MAXSON, AMY (PA C)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:
Last Name:MAXSON
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 1:535 E MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:LANDER
Mailing Address - State:WY
Mailing Address - Zip Code:82520-3424
Mailing Address - Country:US
Mailing Address - Phone:307-233-0553
Mailing Address - Fax:307-337-9029
Practice Address - Street 1:535 E MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:LANDER
Practice Address - State:WY
Practice Address - Zip Code:82520-3424
Practice Address - Country:US
Practice Address - Phone:307-233-0553
Practice Address - Fax:307-337-9029
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2025-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY321363A00000X
AZ8722363AM0700X
WYMD1123075363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY120542100Medicaid
AZZ265974OtherMEDICARE
AZ103077Medicaid
WY314523OtherBSWY
WY605960009OtherFBL