Provider Demographics
NPI:1497828693
Name:MISHRA, AMANDA L (CNS)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:L
Last Name:MISHRA
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:CHRISTINE
Other - Last Name:LAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ACNS
Mailing Address - Street 1:2301 W NORTH LOOP BLVD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78756-2326
Mailing Address - Country:US
Mailing Address - Phone:512-452-2506
Mailing Address - Fax:512-371-0187
Practice Address - Street 1:2301 W NORTH LOOP BLVD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-2326
Practice Address - Country:US
Practice Address - Phone:512-452-2506
Practice Address - Fax:512-371-0187
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX690685364SC1501X, 364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
No364SC1501XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistCommunity Health/Public Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX215039302Medicaid
TX215039302Medicaid
TX468431YKXYMedicare PIN
TXTXB136634Medicare PIN
TXP01361750Medicare PIN