Provider Demographics
NPI:1174173322
Name:MIMS, AMANDA (NP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:MIMS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2255 E MOSSY OAKS RD STE 500
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77389-1813
Mailing Address - Country:US
Mailing Address - Phone:281-440-5300
Mailing Address - Fax:
Practice Address - Street 1:2255 E MOSSY OAKS RD STE 500
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77389-1813
Practice Address - Country:US
Practice Address - Phone:281-440-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-18
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX786538163W00000X
TXAP144957363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse