Provider Demographics
NPI:1023249737
Name:GONZALEZ, AMY CATHLEEN (RN, MSN,FNP,PMHNP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:CATHLEEN
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:RN, MSN,FNP,PMHNP
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Mailing Address - Street 1:97078 N 3620 RD
Mailing Address - Street 2:
Mailing Address - City:PADEN
Mailing Address - State:OK
Mailing Address - Zip Code:74860-7132
Mailing Address - Country:US
Mailing Address - Phone:210-842-3574
Mailing Address - Fax:
Practice Address - Street 1:10 W BROADWAY FL 7
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84101-2060
Practice Address - Country:US
Practice Address - Phone:917-634-5311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-29
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14204040-4405363LP0808X
TX689640363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health