Provider Demographics
NPI:1033744412
Name:OGLE, AMANDA R
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:R
Last Name:OGLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE RIVER ACADEMY
Mailing Address - State:TX
Mailing Address - Zip Code:76554-2615
Mailing Address - Country:US
Mailing Address - Phone:817-458-1369
Mailing Address - Fax:
Practice Address - Street 1:209 N 2ND ST
Practice Address - Street 2:
Practice Address - City:LITTLE RIVER ACADEMY
Practice Address - State:TX
Practice Address - Zip Code:76554-2615
Practice Address - Country:US
Practice Address - Phone:817-458-1369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-06
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX343356164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse