1487850129 NPI number — AMANDA M BURKHALTER CPNP- PC/AC

Table of content: AMANDA M BURKHALTER CPNP- PC/AC (NPI 1487850129)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487850129 NPI number — AMANDA M BURKHALTER CPNP- PC/AC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BURKHALTER
Provider First Name:
AMANDA
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CPNP- PC/AC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487850129
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/16/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
333 N. SANTA ROSA ST
Provider Second Line Business Mailing Address:
CCF BUILDING, 4TH FLOOR NEUROLOGY
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78207
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
102-704-4841
Provider Business Mailing Address Fax Number:
102-704-4952

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
333 N SANTA ROSA
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78207-3108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-704-4841
Provider Business Practice Location Address Fax Number:
210-704-4952
Provider Enumeration Date:
06/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0200X , with the licence number:  657515 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0200X , with the licence number: AP114044 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 285649402 . This is a "CSHCN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 285649401 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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