Provider Demographics
NPI:1083806103
Name:PROUTY, AMANDA (CPM, LM)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:PROUTY
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 RIDGECOVE DR
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-8186
Mailing Address - Country:US
Mailing Address - Phone:972-533-6190
Mailing Address - Fax:469-361-6687
Practice Address - Street 1:1615 RIDGECOVE DR
Practice Address - Street 2:
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-8186
Practice Address - Country:US
Practice Address - Phone:972-533-6190
Practice Address - Fax:469-361-6687
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-13
Last Update Date:2010-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife