Provider Demographics
NPI:1457775249
Name:FALCON, AMANDA CODY (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:CODY
Last Name:FALCON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MRS
Other - First Name:AMANDA
Other - Middle Name:CODY
Other - Last Name:WESBERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 511
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:TX
Mailing Address - Zip Code:75456-0511
Mailing Address - Country:US
Mailing Address - Phone:903-577-6000
Mailing Address - Fax:
Practice Address - Street 1:2001 N JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:TX
Practice Address - Zip Code:75455
Practice Address - Country:US
Practice Address - Phone:903-577-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-13
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX786721363LF0000X
TXAP125188363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily