Provider Demographics
NPI:1831717636
Name:COWART, AMANDA ELLEN (PMHNP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:ELLEN
Last Name:COWART
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:ELLEN
Other - Last Name:BRYANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PMHNP
Mailing Address - Street 1:16561 W DESERT LN
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85388-1152
Mailing Address - Country:US
Mailing Address - Phone:850-217-5937
Mailing Address - Fax:
Practice Address - Street 1:924 N COUNTRY CLUB DR
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-4108
Practice Address - Country:US
Practice Address - Phone:480-222-3205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-08
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ242549363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health