Provider Demographics
NPI:1417467994
Name:DAVIS, AMANDA SELIA (CPNP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:SELIA
Last Name:DAVIS
Suffix:
Gender:
Credentials:CPNP
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:SELIA
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:205 GENE SAMFORD DR
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-3359
Mailing Address - Country:US
Mailing Address - Phone:936-634-2214
Mailing Address - Fax:
Practice Address - Street 1:900 W BLUFF ST
Practice Address - Street 2:
Practice Address - City:WOODVILLE
Practice Address - State:TX
Practice Address - Zip Code:75979-4734
Practice Address - Country:US
Practice Address - Phone:409-283-2090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-10
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP135408363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics