Provider Demographics
NPI:1992304075
Name:GWARDYS-COOK, AMANDA JENKINS (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:JENKINS
Last Name:GWARDYS-COOK
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14441 W MCDOWELL RD STE B102
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-2519
Mailing Address - Country:US
Mailing Address - Phone:480-417-2003
Mailing Address - Fax:480-400-4383
Practice Address - Street 1:12211 W BELL RD STE 104
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85378-9655
Practice Address - Country:US
Practice Address - Phone:480-516-8037
Practice Address - Fax:480-400-4383
Is Sole Proprietor?:No
Enumeration Date:2020-10-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ249201363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health