Provider Demographics
NPI:1972216273
Name:GANT, AMANDA (APRN, PMHNP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:GANT
Suffix:
Gender:F
Credentials:APRN, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4773 CAUGHLIN PKWY
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89519-1011
Mailing Address - Country:US
Mailing Address - Phone:775-221-7400
Mailing Address - Fax:
Practice Address - Street 1:4773 CAUGHLIN PKWY
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89519-1011
Practice Address - Country:US
Practice Address - Phone:775-221-7400
Practice Address - Fax:775-657-6551
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-02
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV862035363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health