Provider Demographics
NPI:1407265515
Name:MCINTIRE, AMANDA (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:
Last Name:MCINTIRE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1333 W 5TH ST STE 110
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-2752
Mailing Address - Country:US
Mailing Address - Phone:307-675-4610
Mailing Address - Fax:307-675-4615
Practice Address - Street 1:1333 W 5TH ST STE 103
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-2752
Practice Address - Country:US
Practice Address - Phone:307-675-4610
Practice Address - Fax:307-675-4615
Is Sole Proprietor?:No
Enumeration Date:2014-08-04
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY27079.1330363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY138296900Medicaid