Rudolph, Amanda B

Rudolph, Amanda B is an individual health care provider with primary practice located at 1011 W Grove St Ste 120 , Kaufman TX 75142-1883. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, Physician Assistants & Advanced Practice Nursing Providers / Pediatrics. Physician Assistants & Advanced Practice Nursing Providers / Pediatrics is her primary health care specialty. Rudolph, Amanda B can be contacted via phone (972) 932-1319.

Contact Information

Primary practice address
1011 W Grove St Ste 120 Kaufman TX 75142-1883
Phone: (972) 932-1319
Fax: (972) 932-1396
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X AP05388 Louisiana
Physician Assistants & Advanced Practice Nursing Providers / Pediatrics 363LP0200X 162093 Texas

Profile Details

NPI number 1043452972
LBN Legal business name Rudolph, Amanda B
Credentials Certified Pediatric Nurse Practitioner (CPNP)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 24th, 2009
Last updated Apr 16th, 2014 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1043452972 NPPES
Mississippi MEDICAID 09079528
Mississippi MEDICAID 1552992

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