Healthcare Provider Details

I. General information

NPI: 1629920814
Provider Name (Legal Business Name): AMANDA ROY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2026
Last Update Date: 02/11/2026
Certification Date: 02/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1207 26TH AVE N
CLINTON IA
52732-1952
US

IV. Provider business mailing address

1207 26TH AVE N
CLINTON IA
52732-1952
US

V. Phone/Fax

Practice location:
  • Phone: 563-559-6155
  • Fax:
Mailing address:
  • Phone: 563-559-6155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA184624
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number151497
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: