Healthcare Provider Details

I. General information

NPI: 1790398915
Provider Name (Legal Business Name): AMY CHARLENE LAND APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2020
Last Update Date: 08/27/2020
Certification Date: 08/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1804 COLLEGE AVE
LEVELLAND TX
79336-6507
US

IV. Provider business mailing address

1804 COLLEGE AVE
LEVELLAND TX
79336-6507
US

V. Phone/Fax

Practice location:
  • Phone: 806-894-3141
  • Fax:
Mailing address:
  • Phone: 806-894-3141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1004300
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: