Healthcare Provider Details

I. General information

NPI: 1750890349
Provider Name (Legal Business Name): AMANDA PARTIN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 DR MICHAEL DEBAKEY DR
LAKE CHARLES LA
70601-5727
US

IV. Provider business mailing address

501 DR MICHAEL DEBAKEY DR
LAKE CHARLES LA
70601-5724
US

V. Phone/Fax

Practice location:
  • Phone: 337-436-3813
  • Fax: 337-493-4355
Mailing address:
  • Phone: 337-312-8528
  • Fax: 337-312-6708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN133944
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP09744
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: