Active NPI
Amanda Elyse Krysiak, DDS
- Dentist
- Gonzales, LA
National Provider Identifier
1083920656
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 25690
- Practice address
- 6419 Pelican Xing
Gonzales, LA 70737-8526 - Phone
- (361) 815-8087
- NPI assigned
- Aug 20, 2010
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 25690 | TX | Primary |
Addresses
Primary practice location
6419 Pelican Xing
Gonzales, LA 70737-8526
Mailing address
6419 Pelican Xing
Gonzales, LA 70737-8526
Phone (361) 815-8087
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1282262400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1282262400000",
"number": "1083920656",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6419 PELICAN XING",
"city": "GONZALES",
"state": "LA",
"postal_code": "707378526",
"telephone_number": "361-815-8087"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6419 PELICAN XING",
"city": "GONZALES",
"state": "LA",
"postal_code": "707378526",
"telephone_number": "361-815-8087"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KRYSIAK",
"first_name": "AMANDA",
"middle_name": "ELYSE",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-08-20",
"last_updated": "2010-08-20",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "TX",
"license": "25690",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gonzales, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.