Provider Demographics
NPI:1962800821
Name:MATHERNE, AMY (MD)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:
Last Name:MATHERNE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:FAKIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6517 SPANISH FORT BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70124
Mailing Address - Country:US
Mailing Address - Phone:504-283-7306
Mailing Address - Fax:504-283-7308
Practice Address - Street 1:6517 SPANISH FORT BLVD
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70124-4321
Practice Address - Country:US
Practice Address - Phone:504-554-2168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-09
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.207327208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics