MEDICARE: AMANDA ELLISOR FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WE0003X	Emergency Registered Nurse	858478	TX
2	363LF0000X	Family Nurse Practitioner	1153063	TX

General Provider Information

NPI Number	:	1225802770
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA ELLISOR FNP

Provider Business Mailing Address
First Line	:	1602 E HOUSTON ST STE C
Second Line	:
City	:	BEEVILLE
State	:	TX
Zip	:	78102-5335
Country	:	US
Telephone Number	:	361-354-2900
Fax Number	:

Provider Business Practice Location Address
First Line	:	1602 E HOUSTON ST STE C
Second Line	:
City	:	BEEVILLE
State	:	TX
Zip	:	78102-5335
Country	:	US
Telephone Number	:	361-354-2900
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/14/2023
Last Update Date	:	05/21/2025

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Directions to “ AMANDA ELLISOR FNP” Practice Location

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