Provider Demographics
NPI:1487850129
Name:BURKHALTER, AMANDA M (CPNP- PC/AC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:M
Last Name:BURKHALTER
Suffix:
Gender:F
Credentials:CPNP- PC/AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 N. SANTA ROSA ST
Mailing Address - Street 2:CCF BUILDING, 4TH FLOOR NEUROLOGY
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78207
Mailing Address - Country:US
Mailing Address - Phone:102-704-4841
Mailing Address - Fax:102-704-4952
Practice Address - Street 1:333 N SANTA ROSA
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-3108
Practice Address - Country:US
Practice Address - Phone:210-704-4841
Practice Address - Fax:210-704-4952
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX657515363LP0200X
TXAP114044363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX285649402OtherCSHCN
TX285649401Medicaid
TXB138091Medicare PIN