Provider Demographics
NPI:1295378966
Name:MCDANIELS, AMANDA RIAN
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:RIAN
Last Name:MCDANIELS
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 1:5012 S US HWY 75
Mailing Address - Street 2:SUITE 300, ATTN BILLING
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75020-4587
Mailing Address - Country:US
Mailing Address - Phone:903-786-3911
Mailing Address - Fax:
Practice Address - Street 1:111 E FM 120 STE 104
Practice Address - Street 2:
Practice Address - City:POTTSBORO
Practice Address - State:TX
Practice Address - Zip Code:75076-7801
Practice Address - Country:US
Practice Address - Phone:903-786-3911
Practice Address - Fax:903-786-8630
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-24
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32232363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner