Provider Demographics
NPI:1114339116
Name:TETHER-ANDERSON, AMY
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:TETHER-ANDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1616 W 6TH ST
Mailing Address - Street 2:APT 133
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-5018
Mailing Address - Country:US
Mailing Address - Phone:256-457-6014
Mailing Address - Fax:
Practice Address - Street 1:1616 W 6TH ST
Practice Address - Street 2:APT 133
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78703-5018
Practice Address - Country:US
Practice Address - Phone:256-457-6014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-24
Last Update Date:2014-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX234195164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse