=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124532098
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMANDA BARBEE MED, ATC, LAT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/29/2017
-----------------------------------------------------
Last Update Date | 05/14/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8779 GREENLEAVES DR
-----------------------------------------------------
City | DENHAM SPRINGS
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70726-6747
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-296-4296
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13103 SOUTHERN VALLEY DR
-----------------------------------------------------
City | PEARLAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77584-3793
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-296-4296
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2255A2300X
-----------------------------------------------------
Taxonomy Name | Athletic Trainer
-----------------------------------------------------
License Number | LAT5149
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2255A2300X
-----------------------------------------------------
Taxonomy Name | Athletic Trainer
-----------------------------------------------------
License Number | 312933
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------