Provider Demographics
NPI:1023867462
Name:SHANKLE, AMANDA MAY (FNP-C)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:MAY
Last Name:SHANKLE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:MAY
Other - Last Name:KOESTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3689 PIN OAK DR
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77301-5835
Mailing Address - Country:US
Mailing Address - Phone:713-256-8695
Mailing Address - Fax:
Practice Address - Street 1:800 RIVERWOOD CT STE 105
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2824
Practice Address - Country:US
Practice Address - Phone:936-760-4454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-17
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1161653363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily