Provider Demographics
NPI:1750890778
Name:RALPH, AMANDA (MSN, APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:RALPH
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 31ST ST
Mailing Address - Street 2:
Mailing Address - City:HONDO
Mailing Address - State:TX
Mailing Address - Zip Code:78861-3512
Mailing Address - Country:US
Mailing Address - Phone:830-423-4234
Mailing Address - Fax:
Practice Address - Street 1:602 31ST ST
Practice Address - Street 2:
Practice Address - City:HONDO
Practice Address - State:TX
Practice Address - Zip Code:78861-3512
Practice Address - Country:US
Practice Address - Phone:830-426-7444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-21
Last Update Date:2017-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP135172207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F09170346OtherAANP CERTIFICATION