Provider Demographics
NPI:1053303511
Name:NYLUND, AMANDA PARKER (MD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:PARKER
Last Name:NYLUND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 HIGHWAY 6
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-4941
Mailing Address - Country:US
Mailing Address - Phone:281-494-4832
Mailing Address - Fax:281-494-7399
Practice Address - Street 1:17500 W GRAND PKWY S
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-2562
Practice Address - Country:US
Practice Address - Phone:281-725-5150
Practice Address - Fax:281-725-5611
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0519207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX173740505Medicaid
TX173740501Medicaid
TX173740504Medicaid
TX8R8311OtherBCBS
TX8K2880Medicare PIN
TX8R8311OtherBCBS
TX173740505Medicaid
TX8K2879Medicare PIN
TX173740501Medicaid