Amanda Dawn Anderson, LVN

Individual provider Active NPI Licensed Vocational Nurse · Jacksonville, TX

NPI 1295233146 · NPPES record last updated Jan 25, 2018

Key facts

NPI
1295233146
Entity type
Individual (NPI type 1)
Primary specialty
Licensed Vocational Nurse 164X00000X
License
210598 (TX)
Practice address
FM 347
Jacksonville, TX 75766
Phone
(936) 585-0455
NPI assigned
Jan 25, 2018
Sex
Female
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
210598TXMDLicensed Vocational Nurse

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Vocational Nurse 164X00000X 210598 TX Yes

Addresses

Primary practice location

FM 347
Jacksonville, TX 75766

Mailing address

21578 FM 343
Cushing, TX 75760-4941

Other providers in Jacksonville, TX

All providers in Jacksonville, TX · Licensed Vocational Nurse in Texas

Sources for this page

Verify at the official NPI Registry.