Healthcare Provider Details

I. General information

NPI: 1770163347
Provider Name (Legal Business Name): AMANDA LEE TILLETT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2021
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1348 PASEO VERDE PKWY STE 100
HENDERSON NV
89012-5723
US

IV. Provider business mailing address

1348 PASEO VERDE PKWY STE 100
HENDERSON NV
89012-5723
US

V. Phone/Fax

Practice location:
  • Phone: 702-847-6252
  • Fax: 702-847-6254
Mailing address:
  • Phone: 702-847-6252
  • Fax: 702-847-6254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number29371
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: