Provider Demographics
NPI:1326504226
Name:LAVENDER, AMBER R (FNP)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:R
Last Name:LAVENDER
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:813 N COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76240-3214
Mailing Address - Country:US
Mailing Address - Phone:806-333-0730
Mailing Address - Fax:
Practice Address - Street 1:800 W HIGHWAY 82
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:TX
Practice Address - Zip Code:76240-2524
Practice Address - Country:US
Practice Address - Phone:940-301-5000
Practice Address - Fax:940-612-8801
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-15
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX833524163W00000X
TXAP137970363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse