Healthcare Provider Details

I. General information

NPI: 1407417108
Provider Name (Legal Business Name): AMANDA HUANG FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2019
Last Update Date: 06/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3555 STAGG DR
BEAUMONT TX
77701-4509
US

IV. Provider business mailing address

570 DIXIE DR
BEAUMONT TX
77707-3816
US

V. Phone/Fax

Practice location:
  • Phone: 409-212-5922
  • Fax:
Mailing address:
  • Phone: 409-718-8564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number869965
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP138228
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: