Provider Demographics
NPI:1093274037
Name:KNOWLES, AMANDA LYNN (RN)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:LYNN
Last Name:KNOWLES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:LYNN
Other - Last Name:LOPEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:829 W HOUSTON ST
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75702-7934
Mailing Address - Country:US
Mailing Address - Phone:903-426-5133
Mailing Address - Fax:
Practice Address - Street 1:829 W HOUSTON ST
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75702-7934
Practice Address - Country:US
Practice Address - Phone:903-426-5133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-19
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX951029163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse