Healthcare Provider Details

I. General information

NPI: 1114339116
Provider Name (Legal Business Name): AMY TETHER-ANDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2014
Last Update Date: 05/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1616 W 6TH ST APT 133
AUSTIN TX
78703-5018
US

IV. Provider business mailing address

1616 W 6TH ST APT 133
AUSTIN TX
78703-5018
US

V. Phone/Fax

Practice location:
  • Phone: 256-457-6014
  • Fax:
Mailing address:
  • Phone: 256-457-6014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number234195
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: