Provider Demographics
NPI:1518460930
Name:AGHERA, AMITA (FNP)
Entity Type:Individual
Prefix:
First Name:AMITA
Middle Name:
Last Name:AGHERA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4495 WANDERING VINE TRL
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78665-1266
Mailing Address - Country:US
Mailing Address - Phone:512-840-1158
Mailing Address - Fax:512-777-5974
Practice Address - Street 1:4495 WANDERING VINE TRL
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-1266
Practice Address - Country:US
Practice Address - Phone:512-840-1158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-12
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP136700363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily