Provider Demographics
NPI:1265789598
Name:MATTHEWS, AMANDA LEA (PA)
Entity type:Individual
Prefix:MISS
First Name:AMANDA
Middle Name:LEA
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:LEA
Other - Last Name:RILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4751 HAMILTON WOLFE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3458
Mailing Address - Country:US
Mailing Address - Phone:210-233-7126
Mailing Address - Fax:
Practice Address - Street 1:4751 HAMILTON WOLFE RD STE 200
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3458
Practice Address - Country:US
Practice Address - Phone:210-233-7126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-06
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA14456363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAT 4744OtherTEXAS DEPARTMENT OF HEALTH