Provider Demographics
NPI:1174097059
Name:MACAFEE, AMY LYNN (LVN)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LYNN
Last Name:MACAFEE
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2209 GLADNELL ST
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:TX
Mailing Address - Zip Code:76574-1310
Mailing Address - Country:US
Mailing Address - Phone:254-688-0525
Mailing Address - Fax:
Practice Address - Street 1:3737 EXECUTIVE CENTER DR STE 250
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-1640
Practice Address - Country:US
Practice Address - Phone:512-340-0171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-14
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX333368164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse