Provider Demographics
NPI:1659519577
Name:CASE, AMANDA KIM (DO)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:KIM
Last Name:CASE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11567 N HIGHWAY 183
Mailing Address - Street 2:
Mailing Address - City:LAMPASAS
Mailing Address - State:TX
Mailing Address - Zip Code:76550-7406
Mailing Address - Country:US
Mailing Address - Phone:512-752-5323
Mailing Address - Fax:
Practice Address - Street 1:11567 N HIGHWAY 183
Practice Address - Street 2:
Practice Address - City:LAMPASAS
Practice Address - State:TX
Practice Address - Zip Code:76550-7406
Practice Address - Country:US
Practice Address - Phone:512-752-5323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-30
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK6998208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice