Provider Demographics
NPI:1548423288
Name:NUNLEY, AMANDA WITT (MD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:WITT
Last Name:NUNLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2232 OAK VLY
Mailing Address - Street 2:
Mailing Address - City:SCHERTZ
Mailing Address - State:TX
Mailing Address - Zip Code:78154-1974
Mailing Address - Country:US
Mailing Address - Phone:210-863-6693
Mailing Address - Fax:
Practice Address - Street 1:902 KITTY HAWK RD
Practice Address - Street 2:SUITE 110
Practice Address - City:UNIVERSAL CITY
Practice Address - State:TX
Practice Address - Zip Code:78148-3825
Practice Address - Country:US
Practice Address - Phone:210-659-0889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-02
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP1-0029052207Q00000X, 207V00000X
TXN5913207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB125053OtherMEDICARE PTAN
TX00R90COtherGROUP PTAN 00R90C