Provider Demographics
NPI:1548661556
Name:MADISON, AMANDA D (FNP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:D
Last Name:MADISON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2941 TIMBER CREEK TRL
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76118-7321
Mailing Address - Country:US
Mailing Address - Phone:469-450-2243
Mailing Address - Fax:469-621-4549
Practice Address - Street 1:4512 RALPH LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75227-1845
Practice Address - Country:US
Practice Address - Phone:972-243-7903
Practice Address - Fax:972-243-7905
Is Sole Proprietor?:No
Enumeration Date:2014-09-09
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP125963363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily