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General NPI Number Information
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NPI Number | 1801680525
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Entity Type | Individual
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Provider Name | AMANDA J VERNON
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Gender | Female
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Dates
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Enumeration Date | 04/07/2025
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Last Update Date | 04/07/2025
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Provider Practice Location Address
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Address Line | 773 BANDIT TRL
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City | KELLER
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State | TX
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Zip | 76248-0111
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Country | US
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Telephone | 817-948-8655
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Fax |
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Provider Business Mailing Address
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Address Line | 10700 AMBLING TRL
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City | FORT WORTH
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State | TX
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Zip | 76108-6943
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Country | US
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Telephone | 817-770-3169
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Fax | 817-770-3169
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-19-99261
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License Number State | TX
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