Healthcare Provider Details

I. General information

NPI: 1427925189
Provider Name (Legal Business Name): AMANDA CASTILLO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2025
Last Update Date: 10/18/2025
Certification Date: 10/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 S TYLER ST
AMARILLO TX
79101-2353
US

IV. Provider business mailing address

6016 GAINSBOROUGH RD
AMARILLO TX
79106-3415
US

V. Phone/Fax

Practice location:
  • Phone: 806-491-1401
  • Fax: 806-553-1258
Mailing address:
  • Phone: 806-626-9826
  • Fax: 806-553-1258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number820902
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: