Amanda Willis, RN IBCLC

Primary specialty

Lactation Consultant (Registered Nurse)Taxonomy code 163WL0100X

License

780850 Issued in TX

Practice address

1621 Lakeville Dr Ste 304
Kingwood, TX 77339-2694

Phone

(281) 305-0411

Fax

(281) 572-0627

NPI assigned

Jan 25, 2022

Last updated

Jan 25, 2022By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Amanda Wilson Professional name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Bayou City Breastfeeding, LLC

  • Lactation Consultant (Registered Nurse)
  • Houston, TX
  • NPI 1376056085
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1643068800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643068800000",
    "number": "1134871775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1621 LAKEVILLE DR STE 304",
            "city": "KINGWOOD",
            "state": "TX",
            "postal_code": "773392694",
            "telephone_number": "281-305-0411",
            "fax_number": "281-572-0627"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1621 LAKEVILLE DR STE 304",
            "city": "KINGWOOD",
            "state": "TX",
            "postal_code": "773392694",
            "telephone_number": "281-305-0411",
            "fax_number": "281-572-0627"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "AMANDA",
        "credential": "RN IBCLC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-01-25",
        "last_updated": "2022-01-25",
        "certification_date": "2022-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WL0100X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Lactation Consultant",
            "state": "VA",
            "license": "L-305357",
            "primary": false
        },
        {
            "code": "163WL0100X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Lactation Consultant",
            "state": "TX",
            "license": "780850",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "https://app.sprucehealth.com/org/entity_12J1SGLTBT000",
            "affiliation": "Y",
            "endpointDescription": "Spruce health",
            "affiliationName": "Bayou City Breastfeeding, LLC",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "spruce health",
            "address_1": "1621 Lakeville Dr Ste 304",
            "city": "Kingwood",
            "state": "TX",
            "country_code": "US",
            "postal_code": "773392694",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "AMANDA",
            "last_name": "WILSON",
            "credential": "RN IBCLC",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Kimberly Williams, LCSW
• Sarah Delaine Williams, BD, PPD, CBC, CBE
• Tamera Nicole Williams
• Josephine D. Williamsen, RPH
• Thia Jade Williamson
• Anthony Willis
• Paula Wilson
• Grace Wimberley
• Winslow Medical Center, Inc. (Kingwood Urgent Care and Special Clinic)
• Winslow Medical Center, Inc. (Kingwood Urgent Care and Special Clinic)

• Lactation Consultant (Registered Nurse) in Kingwood, TX
• Providers in Kingwood, TX by specialty
• Lactation Consultant (Registered Nurse) in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.