Healthcare Provider Details

I. General information

NPI: 1730452012
Provider Name (Legal Business Name): AMANDA D WHITE P.A.-C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA D MONREAL

II. Dates (important events)

Enumeration Date: 02/16/2012
Last Update Date: 08/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5005 S COOPER ST STE 250
ARLINGTON TX
76017-5996
US

IV. Provider business mailing address

5001 S COOPER ST STE 201
ARLINGTON TX
76017-5993
US

V. Phone/Fax

Practice location:
  • Phone: 866-367-8768
  • Fax: 817-541-9540
Mailing address:
  • Phone: 866-367-8768
  • Fax: 817-541-9555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: