Healthcare Provider Details

I. General information

NPI: 1790162626
Provider Name (Legal Business Name): AMANDA EYMARD DNS, APRN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2015
Last Update Date: 05/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5599 LA-311
HOUMA LA
70360
US

IV. Provider business mailing address

5599 LA-311
HOUMA LA
70360
US

V. Phone/Fax

Practice location:
  • Phone: 985-857-3615
  • Fax: 985-857-3765
Mailing address:
  • Phone: 985-857-3615
  • Fax: 985-857-3765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP08263
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: