Provider Demographics
NPI:1124367362
Name:WILHITE, AMANDA BETHANY (PA-C)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:BETHANY
Last Name:WILHITE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6550 FANNIN ST STE 1201
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2740
Mailing Address - Country:US
Mailing Address - Phone:713-441-3372
Mailing Address - Fax:713-797-0622
Practice Address - Street 1:6550 FANNIN ST STE 1201
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2740
Practice Address - Country:US
Practice Address - Phone:713-441-3372
Practice Address - Fax:713-797-0622
Is Sole Proprietor?:No
Enumeration Date:2013-02-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA08248363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX344643702Medicaid
TX8676NMOtherBLUE CROSS BLUE SHIELD
TXPA08248OtherMEDICAL LICENSE
TX344643701Medicaid
TX344643702Medicaid