Provider Demographics
NPI:1043818776
Name:PATTON, AMANDA SUZANNE (FNP)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:SUZANNE
Last Name:PATTON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 WINDING RIVER LN
Mailing Address - Street 2:
Mailing Address - City:SPRING BRANCH
Mailing Address - State:TX
Mailing Address - Zip Code:78070-5785
Mailing Address - Country:US
Mailing Address - Phone:210-387-6809
Mailing Address - Fax:
Practice Address - Street 1:1102 RIVER RD
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-2436
Practice Address - Country:US
Practice Address - Phone:210-387-6809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-14
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1029690363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily