Amanda Lynn Dibenedetto, FNP - C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

AP119335 Issued in TX

Practice address

4513 Williams Dr
Georgetown, TX 78633-1302

Phone

(512) 930-3909

Fax

(512) 869-5868

NPI assigned

Sep 12, 2010

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

Specialty

Nurse Practitioner

Education

Other, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Epiphany Dermatology PAGroup PAC ID 3971827791, 106 clinicians

Mountain West Derm - Blackhart PLLCGroup PAC ID 1153609813, 103 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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

• Epiphany Dermatology PA

  • Dermatology Physician
  • Waco, TX
  • NPI 1043615263
  Medicare reassignment Care Compare group
• Mountain West Derm - Blackhart PLLC

  • Dermatology Physician
  • Georgetown, TX
  • NPI 1366018848
  Medicare reassignment Care Compare group
• Ladera Park Dermatology, P.a.

  • Dermatology Physician
  • Austin, TX
  • NPI 1417010935
  NPD

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

{
    "created_epoch": "1284249600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733097600000",
    "number": "1972810976",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4513 WILLIAMS DR",
            "city": "GEORGETOWN",
            "state": "TX",
            "postal_code": "786331302",
            "telephone_number": "512-930-3909",
            "fax_number": "512-869-5868"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4513 WILLIAMS DR",
            "city": "GEORGETOWN",
            "state": "TX",
            "postal_code": "786331302",
            "telephone_number": "512-930-3909",
            "fax_number": "512-869-5868"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1610 E Whitestone Blvd",
            "address_purpose": "LOCATION",
            "city": "Cedar Park",
            "state": "TX",
            "postal_code": "786136905",
            "country_code": "US",
            "telephone_number": "512-260-3376",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DIBENEDETTO",
        "first_name": "AMANDA",
        "middle_name": "LYNN",
        "name_prefix": "Ms.",
        "credential": "FNP - C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-09-12",
        "last_updated": "2024-12-02",
        "certification_date": "2024-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "AP119335",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "697750",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Diedra Louise Denton, DDS
• Robert F Denyer, DO
• Nisha Desai, O.T.
• Lawrence Devine Jr., PHARMD.
• Jordan Lea Dewberry, RN
• Gwendolyn Marie Dicapo, MA, LPC
• Kennedy Rose Dierckman, PT, DPT
• Jon Fredrick Dietlein, M.D.
• Dustin P Dinh, DDS
• Discover Chiropractic & Wellness, PLLC

• Family Nurse Practitioner in Georgetown, TX
• Providers in Georgetown, TX by specialty
• Family Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.