Provider Demographics
NPI:1831428614
Name:MCANULTY, AMY LYNN (ANP-BC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LYNN
Last Name:MCANULTY
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5425 W SPRING CREEK PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-4268
Mailing Address - Country:US
Mailing Address - Phone:972-596-1059
Mailing Address - Fax:972-612-5410
Practice Address - Street 1:5425 W SPRING CREEK PKWY STE 100
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-4268
Practice Address - Country:US
Practice Address - Phone:972-596-1059
Practice Address - Fax:972-612-5410
Is Sole Proprietor?:No
Enumeration Date:2009-12-08
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX610254363LA2200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX281952601Medicaid
TX8L23587Medicare PIN
TX281952601Medicaid