=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487570438
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMANDA KAY WHORTON RT (R)(CT)
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/24/2026
-----------------------------------------------------
Last Update Date | 06/24/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6900 HARRIS PKWY
-----------------------------------------------------
City | FORT WORTH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76132-4255
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-294-1131
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2928 WILLOW RIDGE CIR
-----------------------------------------------------
City | GRANBURY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76049-7065
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 325-374-0762
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number | 345073
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------