1124626940 NPI number — AMANDA DEANN WILLIAMSON APRN-CNP

Table of content: AMANDA DEANN WILLIAMSON APRN-CNP (NPI 1124626940)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124626940 NPI number — AMANDA DEANN WILLIAMSON APRN-CNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILLIAMSON
Provider First Name:
AMANDA
Provider Middle Name:
DEANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN-CNP
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:
1124626940
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/05/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2215 NASHVILLE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LUBBOCK
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79410-1105
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
806-725-5844
Provider Business Mailing Address Fax Number:
806-723-6532

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12309 FM 3431
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SLATON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79364-1207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-786-2716
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/14/2020

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: 363LF0000X , with the licence number:  1013660 , 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)





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