Provider Demographics
NPI:1982273843
Name:MCDANIEL, AMANDA RENEE (PMHNP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:RENEE
Last Name:MCDANIEL
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:RENEE
Other - Last Name:PURDOM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5637 E FM 4
Mailing Address - Street 2:
Mailing Address - City:GRANDVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:76050-3015
Mailing Address - Country:US
Mailing Address - Phone:817-229-3837
Mailing Address - Fax:
Practice Address - Street 1:5637 E FM 4
Practice Address - Street 2:
Practice Address - City:GRANDVIEW
Practice Address - State:TX
Practice Address - Zip Code:76050-3015
Practice Address - Country:US
Practice Address - Phone:817-229-3837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-23
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1032095363LP0808X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry