Healthcare Provider Details

I. General information

NPI: 1356840169
Provider Name (Legal Business Name): AMANDA KATHERINE CAUSSEAUX FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA KATHERINE GREGORY FNP-C

II. Dates (important events)

Enumeration Date: 02/07/2018
Last Update Date: 03/25/2024
Certification Date: 03/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 MATLOCK RD
MANSFIELD TX
76063-9174
US

IV. Provider business mailing address

PO BOX 99213
FORT WORTH TX
76199-0213
US

V. Phone/Fax

Practice location:
  • Phone: 817-347-8420
  • Fax: 817-347-8495
Mailing address:
  • Phone: 682-885-1860
  • Fax: 682-885-1396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP136442
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: