Provider Demographics
NPI:1316605959
Name:PETERS, AMANDA DAWN (NP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:DAWN
Last Name:PETERS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 HILLSIDE DR
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76240-2920
Mailing Address - Country:US
Mailing Address - Phone:940-594-8672
Mailing Address - Fax:
Practice Address - Street 1:1820 ONEAL ST STE 5
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:TX
Practice Address - Zip Code:76240-3610
Practice Address - Country:US
Practice Address - Phone:940-580-3070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-01
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1059846363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily