Provider Demographics
NPI:1669299178
Name:CALLAHAN, AMANDA BALLEW (MSN, RN)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:BALLEW
Last Name:CALLAHAN
Suffix:
Gender:F
Credentials:MSN, RN
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:DANIELLE
Other - Last Name:DUNACUSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:8329 PRIVATE ROAD 2279
Mailing Address - Street 2:
Mailing Address - City:QUINLAN
Mailing Address - State:TX
Mailing Address - Zip Code:75474-8931
Mailing Address - Country:US
Mailing Address - Phone:972-740-6777
Mailing Address - Fax:
Practice Address - Street 1:3700 WORTH ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-2009
Practice Address - Country:US
Practice Address - Phone:972-740-6777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX802359163WG0000X, 163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice