Healthcare Provider Details

I. General information

NPI: 1295378966
Provider Name (Legal Business Name): AMANDA RIAN MCDANIELS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2019
Last Update Date: 03/22/2024
Certification Date: 03/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 E FM 120 STE 104
POTTSBORO TX
75076-7801
US

IV. Provider business mailing address

5012 S US HWY 75 SUITE 300, ATTN BILLING
DENISON TX
75020-4587
US

V. Phone/Fax

Practice location:
  • Phone: 903-786-3911
  • Fax: 903-786-8630
Mailing address:
  • Phone: 903-786-3911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number32232
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number32232
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: