Provider Demographics
NPI:1154554434
Name:CARLILE, AMANDA L (FNP)
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:L
Last Name:CARLILE
Suffix:
Gender:
Credentials:FNP
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:L
Other - Last Name:CARLILE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DOUGHTY
Mailing Address - Street 1:4530 STONEWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76065-4873
Mailing Address - Country:US
Mailing Address - Phone:469-381-4024
Mailing Address - Fax:972-435-4129
Practice Address - Street 1:4530 STONEWOOD CIR
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:TX
Practice Address - Zip Code:76065-4873
Practice Address - Country:US
Practice Address - Phone:469-381-4024
Practice Address - Fax:972-435-4129
Is Sole Proprietor?:No
Enumeration Date:2009-09-02
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX723684363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX723684OtherFNP
TX723684OtherFNP
TX265472YKY6Medicare PIN