Provider Demographics
NPI:1932360252
Name:DEAN, AMY M (NP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:M
Last Name:DEAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15616 LANDING CREEK LN
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:TX
Mailing Address - Zip Code:76262-3383
Mailing Address - Country:US
Mailing Address - Phone:817-896-0177
Mailing Address - Fax:
Practice Address - Street 1:6225 COLLEYVILLE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-6294
Practice Address - Country:US
Practice Address - Phone:214-556-1300
Practice Address - Fax:214-556-8907
Is Sole Proprietor?:No
Enumeration Date:2008-06-19
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX642328363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX218091101Medicaid
TX218091102Medicaid
TX218091103Medicaid
TXTXB114579Medicare PIN
TX218091101Medicaid
TXTXB114586Medicare PIN