Provider Demographics
NPI:1245230473
Name:WARRINGTON, AMY DIANE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:DIANE
Last Name:WARRINGTON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:D
Other - Last Name:MALLORY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:PO BOX 9101
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-9494
Mailing Address - Country:US
Mailing Address - Phone:972-745-7500
Mailing Address - Fax:972-471-0700
Practice Address - Street 1:2355 E GRAPEVINE MILLS CIR
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-2047
Practice Address - Country:US
Practice Address - Phone:972-539-6330
Practice Address - Fax:972-539-3077
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP113271363LF0000X
TX666203163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX167874001Medicaid
Q24732Medicare UPIN