Provider Demographics
NPI:1659631901
Name:HERNANDEZ, AMY M (MD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:M
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:HLAVATY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:201 FM 3237 STE 111
Mailing Address - Street 2:
Mailing Address - City:WIMBERLEY
Mailing Address - State:TX
Mailing Address - Zip Code:78676-2119
Mailing Address - Country:US
Mailing Address - Phone:512-847-3434
Mailing Address - Fax:512-847-6795
Practice Address - Street 1:201 FM 3237 STE 111
Practice Address - Street 2:
Practice Address - City:WIMBERLEY
Practice Address - State:TX
Practice Address - Zip Code:78676-2119
Practice Address - Country:US
Practice Address - Phone:512-847-3434
Practice Address - Fax:512-847-6795
Is Sole Proprietor?:No
Enumeration Date:2012-05-21
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ0068207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
418733YMG2OtherMEDICARE
P01594333OtherRR MEDICARE
TX192390601Medicaid