Provider Demographics
NPI:1497240725
Name:HARGIS, AMANDA (CNM)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:HARGIS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 ROCK DOVE RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78260-2456
Mailing Address - Country:US
Mailing Address - Phone:931-349-7708
Mailing Address - Fax:
Practice Address - Street 1:5616 LONE STAR PKWY STE 103
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78253-2201
Practice Address - Country:US
Practice Address - Phone:210-281-5066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-28
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN24358367A00000X
TX1033057367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife