Provider Demographics
NPI:1467968024
Name:CULLY, AMANDA K (MS)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:K
Last Name:CULLY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 RAPIDES DR STE A
Mailing Address - Street 2:
Mailing Address - City:NATCHITOCHES
Mailing Address - State:LA
Mailing Address - Zip Code:71457-3105
Mailing Address - Country:US
Mailing Address - Phone:318-206-2991
Mailing Address - Fax:318-625-0636
Practice Address - Street 1:200 RAPIDES DR STE A
Practice Address - Street 2:
Practice Address - City:NATCHITOCHES
Practice Address - State:LA
Practice Address - Zip Code:71457
Practice Address - Country:US
Practice Address - Phone:318-206-2991
Practice Address - Fax:318-625-0636
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-19
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator