Healthcare Provider Details

I. General information

NPI: 1134850159
Provider Name (Legal Business Name): AMANDA LYNN IVERSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2022
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1514 JEFFERSON HWY
NEW ORLEANS LA
70121-2451
US

IV. Provider business mailing address

1514 JEFFERSON HWY
NEW ORLEANS LA
70121-2451
US

V. Phone/Fax

Practice location:
  • Phone: 504-842-3970
  • Fax:
Mailing address:
  • Phone: 504-842-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number332139
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: