Provider Demographics
NPI:1366225591
Name:ATKEISSON, AMY CELESTE
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:CELESTE
Last Name:ATKEISSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:924 COLUMBUS CT
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76022-7514
Mailing Address - Country:US
Mailing Address - Phone:682-552-7726
Mailing Address - Fax:
Practice Address - Street 1:924 COLUMBUS CT
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76022-7514
Practice Address - Country:US
Practice Address - Phone:682-552-7726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104408228363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health