Provider Demographics
NPI:1225893829
Name:SWEATT, AMANDA FAITH
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:FAITH
Last Name:SWEATT
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 1:151 FREESTATE BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71107-6549
Mailing Address - Country:US
Mailing Address - Phone:318-226-5990
Mailing Address - Fax:318-226-5990
Practice Address - Street 1:151 FREESTATE BLVD
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71107-6535
Practice Address - Country:US
Practice Address - Phone:318-226-5990
Practice Address - Fax:318-226-5990
Is Sole Proprietor?:No
Enumeration Date:2024-02-14
Last Update Date:2024-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator