Provider Demographics
NPI:1154185874
Name:DESPAIN, AMANDA ROCHELLE (APRN)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:ROCHELLE
Last Name:DESPAIN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9902 COMPTON RD
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78418-5112
Mailing Address - Country:US
Mailing Address - Phone:956-459-9133
Mailing Address - Fax:
Practice Address - Street 1:1501 S ALAMEDA ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-3109
Practice Address - Country:US
Practice Address - Phone:361-884-2687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-13
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1142664363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily