Provider Demographics
NPI:1366832115
Name:ROSS, AMANDA KATHRYN (PA-C)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:KATHRYN
Last Name:ROSS
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:8170 33RD AVE S # MS 21110Q
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4516
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1415 SAINT FRANCIS AVE
Practice Address - Street 2:
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379-3374
Practice Address - Country:US
Practice Address - Phone:952-993-7750
Practice Address - Fax:952-993-7835
Is Sole Proprietor?:No
Enumeration Date:2015-02-02
Last Update Date:2025-08-29
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Provider Licenses
StateLicense IDTaxonomies
MN11724363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant