Provider Demographics
NPI:1275913360
Name:BROWN, AMANDA KYLE (FNP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:KYLE
Last Name:BROWN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:MARIE
Other - Last Name:KYLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 130
Mailing Address - Street 2:
Mailing Address - City:NEW LLANO
Mailing Address - State:LA
Mailing Address - Zip Code:71461-0130
Mailing Address - Country:US
Mailing Address - Phone:337-239-2207
Mailing Address - Fax:337-239-2583
Practice Address - Street 1:919 S 10TH ST
Practice Address - Street 2:
Practice Address - City:LEESVILLE
Practice Address - State:LA
Practice Address - Zip Code:71446-4613
Practice Address - Country:US
Practice Address - Phone:337-239-2207
Practice Address - Fax:337-239-2583
Is Sole Proprietor?:No
Enumeration Date:2015-06-03
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP08284363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily