MEDICARE: AMANDA MAE DEAVILLEZ APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2100X	Acute Care Nurse Practitioner	1171255	TX

General Provider Information

NPI Number	:	1629800016
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA MAE DEAVILLEZ APRN

Provider Business Mailing Address
First Line	:	7300 ELDORADO PKWY STE 230
Second Line	:
City	:	MCKINNEY
State	:	TX
Zip	:	75070-7896
Country	:	US
Telephone Number	:	972-372-4505
Fax Number	:

Provider Business Practice Location Address
First Line	:	7300 ELDORADO PKWY STE 230
Second Line	:
City	:	MCKINNEY
State	:	TX
Zip	:	75070-7896
Country	:	US
Telephone Number	:	972-372-4505
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2024
Last Update Date	:	03/17/2026

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