Provider Demographics
NPI:1306042569
Name:HANTES, AMY NICOLE (WHCNPC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:NICOLE
Last Name:HANTES
Suffix:
Gender:F
Credentials:WHCNPC
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:HANTES
Other - Last Name:PETERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:WHCNPC
Mailing Address - Street 1:P.O. BOX 961205
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76161-1205
Mailing Address - Country:US
Mailing Address - Phone:817-740-8400
Mailing Address - Fax:
Practice Address - Street 1:3090 RIDGE RD
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-5865
Practice Address - Country:US
Practice Address - Phone:972-475-9505
Practice Address - Fax:972-412-6737
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP110979363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX198894102Medicaid
TX198894101Medicaid
TX198894103Medicaid
TX198894101Medicaid
TX198894103Medicaid
TX198894101Medicaid
TX8L6260Medicare PIN