Provider Demographics
NPI:1386137461
Name:SISUL, AMANDA BRITTANY (PMHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:BRITTANY
Last Name:SISUL
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:MS
Other - First Name:AMANDA
Other - Middle Name:BRITTANY
Other - Last Name:CORLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PMHNP-BC
Mailing Address - Street 1:10600 GLASS MOUNTAIN TRL
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-2503
Mailing Address - Country:US
Mailing Address - Phone:254-913-8095
Mailing Address - Fax:
Practice Address - Street 1:821 W 11TH ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-2009
Practice Address - Country:US
Practice Address - Phone:512-952-2644
Practice Address - Fax:512-668-7885
Is Sole Proprietor?:No
Enumeration Date:2018-06-12
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP140239363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX798018OtherRN LICENSE NUMBER
TXAP140239OtherAPRN
TXAP140239OtherAPRN
TX798018OtherRN LICENSE NUMBER