Healthcare Provider Details

I. General information

NPI: 1245025600
Provider Name (Legal Business Name): AMANDA NICOLE NEPHEW PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2025
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7219 N LITCHFIELD RD
LUKE AFB AZ
85309-1529
US

IV. Provider business mailing address

7219 N LITCHFIELD RD BLDG 1130
LUKE AFB AZ
85309-1529
US

V. Phone/Fax

Practice location:
  • Phone: 623-856-2273
  • Fax:
Mailing address:
  • Phone: 623-856-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: