Healthcare Provider Details

I. General information

NPI: 1669299178
Provider Name (Legal Business Name): AMANDA BALLEW CALLAHAN MSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA DANIELLE DUNACUSKY RN

II. Dates (important events)

Enumeration Date: 09/25/2024
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 WORTH ST
DALLAS TX
75246-2009
US

IV. Provider business mailing address

8329 PRIVATE ROAD 2279
QUINLAN TX
75474-8931
US

V. Phone/Fax

Practice location:
  • Phone: 972-740-6777
  • Fax:
Mailing address:
  • Phone: 972-740-6777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number802359
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number802359
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: