Provider Demographics
NPI:1114587854
Name:WHATLEY, AMANDA RENEE (CPM, LM)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:RENEE
Last Name:WHATLEY
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 1:240 MOONLIGHT TRL
Mailing Address - Street 2:
Mailing Address - City:STEPHENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76401-2138
Mailing Address - Country:US
Mailing Address - Phone:480-817-8317
Mailing Address - Fax:
Practice Address - Street 1:270 BARKER ST
Practice Address - Street 2:
Practice Address - City:STEPHENVILLE
Practice Address - State:TX
Practice Address - Zip Code:76401-1904
Practice Address - Country:US
Practice Address - Phone:480-817-8317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-14
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX99373176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife