Healthcare Provider Details

I. General information

NPI: 1700205291
Provider Name (Legal Business Name): AMANDA ELIZABETH STEWART PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA ELIZABETH GARRETT PA

II. Dates (important events)

Enumeration Date: 04/10/2014
Last Update Date: 09/11/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24510 NORTHWEST FWY STE 120
CYPRESS TX
77429-2199
US

IV. Provider business mailing address

24510 NORTHWEST FWY STE 120
CYPRESS TX
77429-2199
US

V. Phone/Fax

Practice location:
  • Phone: 346-618-3420
  • Fax: 346-618-3421
Mailing address:
  • Phone: 346-618-3420
  • Fax: 346-618-3421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA09007
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA09007
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: