Healthcare Provider Details

I. General information

NPI: 1043726557
Provider Name (Legal Business Name): AMANDA GAMMEL JAMES PCPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2017
Last Update Date: 05/30/2024
Certification Date: 05/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 W LAFAYETTE ST
WINNFIELD LA
71483-3463
US

IV. Provider business mailing address

PO BOX 197
DEVILLE LA
71328-0197
US

V. Phone/Fax

Practice location:
  • Phone: 318-648-0375
  • Fax:
Mailing address:
  • Phone: 318-229-3399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAP09531
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: