Provider Demographics
NPI:1124537477
Name:BIERY, AMANDA BLYTHE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:BLYTHE
Last Name:BIERY
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 1:2455 DUNSTAN RD APT 473
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77005-2315
Mailing Address - Country:US
Mailing Address - Phone:361-739-1569
Mailing Address - Fax:
Practice Address - Street 1:22659 HIGHWAY 59 N STE 140
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-4504
Practice Address - Country:US
Practice Address - Phone:281-973-4159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-28
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA11465363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical