MEDICARE: AMANDA MCCARTY PA-C

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	363A00000X	Physician Assistant	PA02573	TX

General Provider Information

NPI Number	:	1295779247
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA MCCARTY PA-C

Provider Business Mailing Address
First Line	:	363 COUNTY ROAD 776
Second Line	:
City	:	DOUGLASS
State	:	TX
Zip	:	75943-4301
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4848 NE STALLINGS DR
Second Line	:	SUITE 205
City	:	NACOGDOCHES
State	:	TX
Zip	:	75965-1239
Country	:	US
Telephone Number	:	936-560-6939
Fax Number	:	936-564-1258

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

Provider Enumeration Date	:	06/16/2006
Last Update Date	:	07/08/2007

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