MEDICARE: DR. AMANDA WITT NUNLEY M.D.

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	207Q00000X	Family Medicine Physician	BP1-0029052	TX
2	207V00000X	Obstetrics & Gynecology Physician	BP1-0029052	TX
3	207Q00000X	Family Medicine Physician	N5913	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	TXB125053	OTHER	TX	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	00R90C	OTHER	TX	GROUP PTAN 00R90C

General Provider Information

NPI Number	:	1548423288
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMANDA WITT NUNLEY M.D.

Provider Business Mailing Address
First Line	:	2232 OAK VLY
Second Line	:
City	:	SCHERTZ
State	:	TX
Zip	:	78154-1974
Country	:	US
Telephone Number	:	210-863-6693
Fax Number	:

Provider Business Practice Location Address
First Line	:	902 KITTY HAWK RD
Second Line	:	SUITE 110
City	:	UNIVERSAL CITY
State	:	TX
Zip	:	78148-3825
Country	:	US
Telephone Number	:	210-659-0889
Fax Number	:

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

Provider Enumeration Date	:	07/02/2008
Last Update Date	:	11/17/2021

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Directions to “ DR. AMANDA WITT NUNLEY M.D.” Practice Location

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