Provider Demographics
NPI:1467910034
Name:HUERTA, AMANDA DELISE
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:DELISE
Last Name:HUERTA
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 1:1907 E AVE
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68847-6236
Mailing Address - Country:US
Mailing Address - Phone:816-266-0060
Mailing Address - Fax:
Practice Address - Street 1:3721 W 13TH ST STE A
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-3205
Practice Address - Country:US
Practice Address - Phone:308-210-2205
Practice Address - Fax:308-210-2206
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-03
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE114057363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health