Provider Demographics
NPI:1215265236
Name:HEDGES, AMANDA M (M MSN CPN)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:M
Last Name:HEDGES
Suffix:
Gender:F
Credentials:M MSN CPN
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:M
Other - Last Name:BABYAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:M MSN CPN
Mailing Address - Street 1:205 E UNIVERSITY AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626-6821
Mailing Address - Country:US
Mailing Address - Phone:512-868-1124
Mailing Address - Fax:512-868-9894
Practice Address - Street 1:2423 WILLIAMS DR STE 103
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-3200
Practice Address - Country:US
Practice Address - Phone:877-800-5722
Practice Address - Fax:512-930-7400
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-02
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP112440363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAP112440OtherSTATE BOARD OF NURSING LICENSEPEDIATRIC NURSE PRACTITIONER
TX640141OtherSTATE BOARD OF NURSING LICNESEREGISTERED NURSE
TX2134280-01Medicaid