Healthcare Provider Details

I. General information

NPI: 1760670392
Provider Name (Legal Business Name): AMANDA BLOUNT ERMIS DNP, AGACNP, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2007
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 SETON PKWY STE 125
KYLE TX
78640-4076
US

IV. Provider business mailing address

8701 N MOPAC EXPY STE 105
AUSTIN TX
78759-8364
US

V. Phone/Fax

Practice location:
  • Phone: 512-788-9688
  • Fax: 512-268-7200
Mailing address:
  • Phone: 512-687-1970
  • Fax: 512-407-9010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number1158756
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: