Amanda Frederick, NP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

1084549 Issued in TX

Practice address

1110 N Sarah Dewitt Dr
Gonzales, TX 78629-3311

Phone

(830) 672-8502

Fax

(830) 541-5557

NPI assigned

Aug 8, 2024

Last updated

Aug 8, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

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.

• Gonzales Healthcare Systems

  dba Sievers Medical Clinic

  • Rural Health Clinic/Center
  • Gonzales, TX
  • NPI 1013916287
  Medicare reassignment NPD
• Gonzales Healthcare Systems

  dba Memorial Hospital Home Health

  • Home Health Agency
  • Gonzales, TX
  • NPI 1437158714
  Authorized official Same address or phone
• Gonzales Healthcare Systems

  dba Memorial Hospital

  • General Acute Care Hospital
  • Gonzales, TX
  • NPI 1508859612
  NPD

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

{
    "created_epoch": "1723075200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723075200000",
    "number": "1922839448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 587",
            "city": "GONZALES",
            "state": "TX",
            "postal_code": "786290587",
            "telephone_number": "830-672-9508",
            "fax_number": "830-670-3093"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1110 N SARAH DEWITT DR",
            "city": "GONZALES",
            "state": "TX",
            "postal_code": "786293311",
            "telephone_number": "830-672-8502",
            "fax_number": "830-541-5557"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FREDERICK",
        "first_name": "AMANDA",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-08-08",
        "last_updated": "2024-08-08",
        "certification_date": "2024-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "TX",
            "license": "785626",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TX",
            "license": "1084549",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ez Senior Care
• Family Dentistry of Gonzales
• Familylink Treatment Services
• Jaycee Fike
• Karen Fortune
• Philip Fuentes, HIS
• Gary James Gage, O.D.
• Gabriel Gallardo, M.ED., LPC
• Iris Galvez
• Gary J Gage

• Nurse Practitioner in Gonzales, TX
• Providers in Gonzales, TX by specialty
• Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.