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General NPI Number Information
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NPI Number | 1871751636
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Entity Type | Individual
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Provider Name | AMANDA GAYLE EDWARDS AUD
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Gender | Female
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Dates
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Enumeration Date | 05/29/2008
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Last Update Date | 04/25/2023
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Provider Practice Location Address
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Address Line | 2210 THREE LAKES PKWY STE 100
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City | TYLER
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State | TX
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Zip | 75703-0642
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Country | US
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Telephone | 903-747-4050
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Fax |
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Provider Business Mailing Address
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Address Line | 2210 THREE LAKES PKWY STE 100
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City | TYLER
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State | TX
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Zip | 75703-0642
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Country | US
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Telephone | 903-747-4050
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Fax |
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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 | 2355A2700X
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Taxonomy Name | Audiology Assistant
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License Number | 51162
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 51162
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License Number State | TX
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