Healthcare Provider Details

I. General information

NPI: 1639090707
Provider Name (Legal Business Name): AMANDA PRATT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 FILLMORE ST STE 1230
SAN FRANCISCO CA
94115-2708
US

IV. Provider business mailing address

2021 FILLMORE ST STE 1230
SAN FRANCISCO CA
94115-2708
US

V. Phone/Fax

Practice location:
  • Phone: 707-652-3925
  • Fax: 888-616-1584
Mailing address:
  • Phone: 707-652-3925
  • Fax: 888-616-1584

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2022007979
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: